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PubMed2006

Predictors of driving assessment outcome in Parkinson's disease.

This study evaluated selected clinical and functional tests as predictors of driving safety outcomes in Parkinson's disease (PD) patients. A total of 25 PD patients and 21 age-matched controls, all regular drivers, underwent neurological evaluation and assessment of cognitive, visual, and motor function and a standardized, on-road driving assessment. The capacity of the tests to predict pass/fail driving outcomes was determined by selecting a subset with the highest predictive value from each domain and then subjecting these subsets to discriminant function analysis. Accuracy, sensitivity, specificity, and positive and negative predictive values were determined. Three relatively simple tests from the larger battery predicted passes with relatively high sensitivity (PD, 72.7%; controls, 93.8%; both combined, 85.2%); and moderate specificity (PD, 64.3%; controls, 60.0%; both combined. 63.2%). These tests assessed motor performance (Purdue Pegboard test), contrast sensitivity (Pelli-Robson test), and cognitive function (verbal version of Symbol Digit Modalities test). Adding time since diagnosis for the PD group increased sensitivity to 90.9% and specificity to 71.4%. These simple tests confer more objectivity and predictive power to clinical recommendations for driving, they reflect distinct functions that are necessary for safe driving, and they may be especially useful when on-road assessments are not feasible.

Activities of Daily Living↗
PubMed2005

[Status of rendering an expert opinion following the changes in the German traffic legislation].

The new traffic legislation in Germany ("FeVAndV") solves at least the most urgent problems for the ophthalmological driver's license assessment which were present in the old, preceding regulations ("FeV"). Many suggestions of the traffic committee of the German Ophthalmological Society ("DOG") were taken into consideration. As expected, the recommendations of the traffic committee concerning an obligatory test of mesopic vision were not adopted into the new legislation. We still have the unacceptable situation that on the one hand the European legislation demands an obligatory test of mesopic vision in suspected candidates and the German legislation even has the necessary key note for a ban on night driving ("05.01"). On the other hand, testing of mesopic vision is not considered on a regular basis in the new German regulations. This is not acceptable from an ophthalmological point of view.

Automobile Driver Examination↗
PubMed1989

Self-evaluation of drivers' skill: a cross-cultural comparison.

In a study conducted in Sweden and the United States, subjects judged their own driving skills in relation to other drivers. The results showed that a majority of subjects regarded themselves as more skillful than the average driver. This result was compared with that obtained from similar studies on the population of Polish amateur and professional drivers. The outcomes of this comparison confirmed the existence of an optimistic tendency to overestimate one's own driving skill. This tendency was observed in various groups of drivers differing in cultural background. Finally, the influence of this tendency upon risk estimates of traffic accidents and inefficiency of safety propaganda are discussed.

Accidents, Traffic↗
PubMed1990

Safety effects of relaxing California's clean-record requirement for driver license renewal by mail.

A pilot program was established in California in 1982 authorizing mail renewal of driver licenses for persons under age 70 lacking clean (accident- and conviction-free) 4-year driving records, but showing clean 2-year records at selection. Such drivers constitute about 14% of California's renewal population, or about 500,000 renewees per year. Eligible drivers whose licenses expired in 1983 were subjects of the present study. Half of them were randomly assigned to a group whose members were sent offers of renewal by mail and the other half were sent standard renewal notices requiring appearance in a field office and successful completion of vision and traffic law tests. Traffic accidents and convictions following the mailout of these documents were tracked for both groups; results presented here cover a 4-year period subsequent to mailout. During this period (a normal license term in California), no significant overall difference was shown between the groups with respect to subsequent convictions or accidents. However, significant detrimental effects on accidents were noted for a subgroup of drivers who had experienced recent traffic violations or accidents which were not on their records at selection. Implications of these results are discussed.

Accidents, Traffic↗
PubMed1995

Medical conditions, risk exposure, and truck drivers' accidents: an analysis with count data regression models.

Recent studies do not agree on the possible relationship between medical conditions and traffic safety; most of them do not control for exposure factors. This problem has become more pertinent for scientific studies because of litigation that showed that present regulations about access to driver permits might contravene human rights legislation. In our study, we estimate the effect of different medical conditions on truck drivers' distributions of accidents. Our data and our models permit simultaneous control for age; medical conditions; exposure factors measured by hours, kilometer, and qualitative factors; and other characteristics of truck drivers. Our results show that diabetic truck drivers of the permit class for straight trucks have more accidents than drivers in good health. No other studied medical condition has a significant effect on individual accident distributions. Many risk exposure variables are also significant. The effect of age is discussed in detail.

Accidents, Occupational↗
PubMed1996

An evaluation of the New Zealand graduated driver licensing system.

Young drivers have a disproportionately high risk of experiencing a road traffic crash. On 1 August 1987 a Graduated Driver's Licensing System (GDLS) was introduced in New Zealand. This system was designed to give young drivers (i.e. 15-24 years inclusive) experience in driving while being excluded from high risk driving situations. We sought to determine the impact of the GDLS on serious injury crashes. The source of the injury crash data was New Zealand's Health Information Services' national public hospital inpatient morbidity data files for the years 1979-1992 inclusive. We disaggregated the occupant data into three age groups 15-19 years, 20-24 years, and persons 25 years of age or older and compared their trends in injury. In order to determine whether the incidence of motor vehicle crashes was simply following trends in other injury events we also included two 15-19 year old non-traffic injury comparison groups. Using time series analyses we showed that the introduction of the GDLS was closely followed by substantial reductions in car crash injuries for all age groups, especially 15-19 year olds (23% reduction). After considering effects for older occupants we speculate that the effect is likely to be substantially less than 23%. An analysis of licensure data suggests that the reduction in crashes may, in large part, be attributable to an overall reduction in exposure.

Accidents, Traffic↗
PubMed1996

Medical conditions and the severity of commercial motor vehicle drivers' road accidents.

In this research we studied the association between commercial motor vehicle drivers' medical conditions and crash severity. Some aspects of medical condition were considered. To our knowledge, no study has ever isolated this association. The severity of a crash was measured by the total number of victims (injured and dead). We estimated nonlinear regression models (specifically, Poisson and negative binomial) which incorporated, simultaneously, information on drivers' characteristics, crash circumstances and health status, in order to isolate the association between health status and crash severity. Our results show that crashes of truck drivers with binocular vision problems and bus drivers with hypertension are more severe than those of healthy drivers. No other medical condition considered in this study was significantly associated with crash severity. Many variables describing crash circumstances were also significant.

Accidents, Occupational↗
PubMed1996

Young novice drivers: towards a model of their accident involvement.

There are two main purposes of this article. The first is to present a model of young drivers' accident involvement, including the most important processes in the development of their driving behaviour. The model describes the relations between the learning process, the individual preconditions and the social influence and how these are related to driving behaviour and accident involvement through different processes such as skill acquisition, self assessment, information processing, feedback and motivation. The second purpose is to present a state-of-the-art report for the different aspects of the model by referring to some of the literature on young drivers.

Accidents, Traffic↗
PubMed1996

Does license disqualification reduce reoffence rates?

A review was conducted of the subsequent driving records of over 25,000 Queensland drivers cited for a drink driving offence in 1988 who received at least one subsequent license restriction. The interval of follow-up was at least 3 years, average 3.9 years. Periods of driving disqualification were identified and, for each driver, the total amount of time during restricted and unrestricted driving was computed; the numbers of events, i.e. crashes and traffic offences, recorded during these periods were counted. Rates under disqualification and during legal driving, expressed per thousand person-years were derived by dividing total numbers of events by total time during which they could occur. Three categories of traffic violation were considered: drink driving offences; traffic offences unassociated with drink driving, and any offence involving driving. Since only 12% of the offenders and 9% of the reoffenders were female, detailed analyses are presented for men only; results for women were little different. Statistical inference assumed a Poisson model for crashes and a negative binomial model for offences, and analyses were performed after stratification by number of drink driving offences. Calculated rates during periods of disqualification were about one third of the rates during legal driving for crashes and all three categories of traffic offence, ranging from 25% in the case of unassociated offences to 35% for any driving offence. There were differences, some statistically significant, by age and between metropolitan, provincial city and rural regions of the State, but most were relatively minor. Drivers were apprehended more frequently earlier in the disqualification period than later. It is impossible from these data to distinguish between reduced driving levels and more cautious traffic behaviour during periods of license restriction. It is nonetheless clear that while such penalties are in operation, they substantially reduce the negative impact of convicted drink-drivers on the road. Unfortunately the data do not permit one to say whether or for how long the effect persists.

Accidents, Traffic↗
PubMed2001

Predicting at-fault car accidents of older drivers.

Considerable research shows car accidents are difficult to predict using screening tests. The objective of this exploratory study is to determine whether detailed accident analysis taking into account the specific accident type might enhance the predictive power of a standardised road test and a set of selected neuropsychological tests. Moreover, this study addresses the validity and reliability of performance-based driving evaluation. The sample consisted of 84 older drivers between 65 and 96 years of age who were referred for a fitness-to-drive evaluation. Using discriminant analyses, the subjects were classified as drivers with and without at-fault accidents. We compared the accuracy of neuropsychological tests and a road test for postdicting all accidents, accidents classified into two categories and accidents classified into four different categories. The percentages of correctly classified subject were highest at the level of the most detailed classification. These results suggest that, although accident prediction is difficult, the predictability of car accidents by neurocognitive measurements and a road test increases when the kind of accident is specified.

Accidents, Traffic↗
PubMed1996

Neuropsychological driving fitness tests for brain-damaged subjects.

OBJECTIVES: The study was carried out to evaluate and develop simple tools to assess the driving fitness of brain-damaged patients. DESIGN: Four neuropsychological tests (predictors) were validated against an open-road driving test (criterion standard), which is used by the Department of Adaptations of the Dutch Driving Licensing Agency for assessing disabled drivers. SETTINGS: The predictor tests were conducted in the involved scientific institute; the criterion standard involved participation in normal traffic. PATIENTS: The subject group consisted of 33 men and 5 women who had recovered to a stabilized level from traumatic brain injuries. All had valid driving licenses when they were injured and they were considered to be potentially able to recommence driving. The subjects had a mean reported driving experience of 109.200km (SD = 86.300km). All subjects were recovered from a brain trauma with an average coma duration of 33 days (SD = 51 days). They were tested at least 1 year after the accident. All the subjects had normal or corrected-to-normal vision and none used medications that, according to existing medical criteria, interfere with normal psychomotor or cognitive functioning. Ages at the time of the injury were between 17 and 55 years (mean, 29.8; SD, 10.9). MAIN OUTCOME MEASURES: Pearson product moment correlations (and explained variances) were calculated between the four predictor tests (a Perceptual Speed test, the WAIS Symbol-Digit Substitution subtest, a Tracking-Reaction dual task, and a Time Estimation task) and the open-road criterion standard. RESULTS: The results indicated that performance on both the Perceptual Speed task and the Time Estimation task were significantly correlated with driving performance (p < or = .05). When combined with coma duration and driving experience, the Perceptual Speed and Tracking-Reaction tests together explained 35.3% (r = .59) of the variance in on-road driving performance. CONCLUSIONS: The amount of variance in open-road driving performance that could be accounted for by these tests was insufficient to completely replace an open-road driving fitness assessment. Also, based on other experimental documentation, it is concluded that more integral, domain-specific test (eg, based on driving simulation) need to be developed.

Adolescent↗
PubMed1998

Teenage driving fatalities.

BACKGROUND/PURPOSE: A recent legislative effort in New Hampshire to institute a graduated licensing system for teenagers (TA) led to an analysis of state data on fatal crashes involving TA drivers. This provides an overview of these events and suggests possible prevention strategies. METHODS: Data on fatal crashes involving TA drivers was obtained for the years 1991 through 1996 from the Fatal Accident Unit, Division of State Police, New Hampshire Department of Safety. RESULTS: From 1991 through 1996, there were 100 events resulting in 109 total deaths, of which 76 were TA. Five involved motorcycles. Four drivers struck pedestrians, and two struck children on bicycles. In one case, an object fell from a truck, crushing a car. The remaining 88 were single- or multiple-car crashes, and these were analyzed further. Two thirds of the drivers were boys. The driver breakdown by age was 15 years, 3; 16 years, 21; 17 years, 26; 18 years, 20; 19 years, 18. The TA driver was killed in 47% of the events. Nineteen percent resulted in the death of the driver of another car. In 62 events, there were passengers in the TA's car, and in 55% of these, a passenger was killed. Twenty percent of the crashes involved drugs or alcohol, and almost two thirds of these occurred between 10:00 PM and 6:00 AM. Seat belts were not used by at least 72% of those injured fatally. In 59%, known traffic violations, usually speeding, contributed. More detailed data were available for 1995 through 1996, during which there were 30 crashes resulting in 33 deaths. Speed limit did not correlate with number of crashes. One-car crashes outnumbered multiple-car, 57% to 43%. Ninety percent occurred on single-lane roads. Most significantly, 63% of the drivers had been licensed less than 1 year and 47% less than 6 months. In this latter group, drugs and alcohol played no role, and none occurred between 11:00 PM and 6:00 AM. CONCLUSIONS: Two at-risk groups exist. The first is inexperienced sober TA drivers on single-lane roads during conventional hours. As experience increases, the second group appears: TA who have been drinking and are out late at night. Prevention strategies must take into account these two groups.

Accidents, Traffic↗
PubMed1966

Vision for driving.

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Automobile Driver Examination↗