A Systematic Review of the Risk of Motor Vehicle Collision in Patients With Syncope

Chee, Justin N.; Simpson, Chris; Sheldon, Robert S.; Dorian, Paul; Dow, Jamie; Guzmán, Juan C.; Raj, Satish R.; Sandhu, Roopinder K.; Thiruganasambandamoorthy, Venkatesh; Green, Martin S.; Krahn, Andrew D.; Plonka, Sarah C.; Rapoport, Mark J.

doi:10.1016/j.cjca.2020.02.070

Cited by 9 publications

(12 citation statements)

References 24 publications

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“…Other studies on syncope and crash risk either fail to include a control group or simply compare to publicly reported crash risks in the general population. 11,14 Our findings have implications for clinicians and policymakers charged with making recommendations about fitness-to-drive after syncope. Fitness-to-drive decisions typically depend on the magnitude, not merely the presence, of increased risk: In many jurisdictions, nonzero blood alcohol concentrations (BACs) that double crash risk are not subject to any penalty (i.e.…”

Section: Discussionmentioning

confidence: 89%

“…Our findings advance the scientific understanding of syncope and crash risk by complementing and enhancing the interpretation of prior studies. 11 Using the syncope cohort described above, we recently reported that 9,223 individuals visiting the ED for syncope had a crash-free survival no different than 34,366 controls visiting the ED for other conditions (0-30 days, hazard ratio 0.93, 95%CI 0.78-1.11; 30-90 days, hazard ratio 1.07, 95%CI 0.84-1.36). 13 Using a similar cohort design, Numé and colleagues reported that 41,039 Danish patients visiting the ED or hospital for syncope had a modest increase in the rate of traffic injuries relative to the general population (≤1 month, rate ratio 1.25, 95%CI 0.94-1.67; 1-3 months, rate ratio 1.56, 95%CI 1.30-1.87).…”

Section: Discussionmentioning

confidence: 99%

“…Other studies on syncope and crash risk either fail to include a control group or simply compare to publicly reported crash risks in the general population. 11,14…”

Section: Discussionmentioning

confidence: 99%

“…8,9,10 Two recently published population-based studies address many of these limitations and together increased the number of patients in the published literature on syncope and driving by 26-fold. 11 A Danish study found that 41,039 individuals visiting a hospital or emergency department with first-episode syncope subsequently sustained crash injuries at nearly twice the rate observed in the general population. 12 In contrast, we found that 9,223 drivers visiting an emergency department in Canada for first-episode syncope had a risk of subsequent crash no different than 34,366 drivers with an emergency visit for a condition other than syncope.…”

Section: Introductionmentioning

confidence: 99%

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Syncope and subsequent traffic crash: A responsibility analysis

Staples

Erdelyi

Merchant

et al. 2022

Preprint

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Background: Physicians are often asked to counsel patients about driving safety after syncope, yet little empirical data guides such advice. Methods: We identified a population-based retrospective cohort of 9,507 individuals with a driver license who were discharged from any of six urban emergency departments (EDs) with a diagnosis of 'syncope and collapse'. We examined all police-reported crashes that involved a cohort member as a driver and occurred between 1 January 2010 and 31 December 2016. We categorized crash-involved drivers as 'responsible' or 'non-responsible' for their crash using detailed police-reported crash data and a validated responsibility scoring tool. We then used logistic regression to test the hypothesis that recent syncope was associated with driver responsibility for crash. Results: Over the 7-year study interval, cohort members were involved in 475 police-reported crashes: 210 drivers were deemed responsible and 133 drivers were deemed non-responsible for their crash; the 132 drivers deemed to have indeterminate responsibility were excluded from further analysis. An ED visit for syncope occurred in the three months leading up to crash in 11 crash-responsible drivers and in 5 crash-non-responsible drivers, suggesting that recent syncope was not associated with driver responsibility for crash (adjusted odds ratio, 1.31; 95%CI, 0.40-4.74; p=0.67). However, all drivers with cardiac syncope were deemed responsible, precluding calculation of an odds ratio for this important subgroup. Conclusions: Recent syncope was not significantly associated with driver responsibility for traffic crash. Clinicians and policymakers should consider these results when making fitness-to-drive recommendations after syncope.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

“…Other studies on syncope and crash risk either fail to include a control group or simply compare to publicly reported crash risks in the general population. 11,14…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Syncope and subsequent traffic crash: A responsibility analysis

Staples

Erdelyi

Merchant

et al. 2022

Preprint

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show abstract

“…Prior to the adaptation of a specific stratification score into guidelines, there is a need for updated head‐to‐head studies with a focus on the decision to admit, the choice of subsequent diagnostic tests, patient safety, and cost‐effectiveness. There is question on whether a syncopal presentation to an ED warrants motor vehicle license restriction 39 . The studies in this review did not include motor vehicle accidents as an adverse event and thus decisions on license suspension cannot be extrapolated from these results.…”

Section: Future Directionsmentioning

confidence: 99%

Multivariable risk scores for predicting short‐term outcomes for emergency department patients with unexplained syncope: A systematic review

Sweanor

Redelmeier

Simel

et al. 2021

Academic Emergency Medicine

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Objectives: Emergency department (ED) patients with unexplained syncope are at risk of experiencing an adverse event within 30 days. Our objective was to systematically review the accuracy of multivariate risk stratification scores for identifying adult syncope patients at high and low risk of an adverse event over the next 30 days. Methods:We conducted a systematic review of electronic databases (MEDLINE, Cochrane, Embase, and CINAHL) from database creation until May 2020. We sought studies evaluating prediction scores of adults presenting to an ED with syncope. We included studies that followed patients for up to 30 days to identify adverse events such as death, myocardial infarction, stroke, or cardiac surgery. We only included studies with a blinded comparison between baseline clinical features and adverse events. We calculated likelihood ratios and confidence intervals (CIs).Results: We screened 13,788 abstracts. We included 17 studies evaluating nine risk stratification scores on 24,234 patient visits, where 7.5% (95% CI = 5.3% to 10%) experienced an adverse event. A Canadian Syncope Risk Score (CSRS) of 4 or more was associated with a high likelihood of an adverse event (LR score≥4 = 11, 95% CI = 8.9 to 14). A CSRS of 0 or less (LR score≤0 = 0.10, 95% CI = 0.07 to 0.20) was associated with a low likelihood of an adverse event. Other risk scores were not validated on an independent sample, had low positive likelihood ratios for identifying patients at high risk, or had high negative likelihood ratios for identifying patients at low risk. Conclusion:Many risk stratification scores are not validated or not sufficiently accurate for clinical use. The CSRS is an accurate validated prediction score for ED patients with unexplained syncope. Its impact on clinical decision making, admission rates, cost, or outcomes of care is not known.

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Syncope and the Risk of Subsequent Motor Vehicle Crash

et al. 2022

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IMPORTANCE Medical driving restrictions are burdensome, yet syncope recurrence while driving can cause a motor vehicle crash (MVC). Few empirical data inform current driving restrictions after syncope. OBJECTIVE To examine MVC risk among patients visiting the emergency department (ED) after first-episode syncope. DESIGN, SETTING, AND PARTICIPANTSA population-based, retrospective observational cohort study of MVC risk after first-episode syncope was performed in British Columbia, Canada. Patients visiting any of 6 urban EDs for syncope and collapse were age-and sex-matched to 4 control patients visiting the same ED in the same month for a condition other than syncope. Patients' ED medical records were linked to administrative health records, driving history, and detailed crash reports. Crash-free survival among individuals with syncope was then compared with that among matched control patients. Data analyses were performed from May 2020 to March 2022. EXPOSURES Initial ED visit for syncope.MAIN OUTCOMES AND MEASURES Involvement as a driver in an MVC in the year following the index ED visit. Crashes were identified using insurance claim data and police crash reports. RESULTSThe study cohort included 43 589 patients (9223 patients with syncope and 34 366 controls; median [IQR] age, 54 years; 22 360 [51.3%] women; 5033 [11.5%] rural residents). At baseline, crude MVC incidence rates among both the syncope and control groups were higher than among the general population (12.2, 13.2, and 8.2 crashes per 100 driver-years, respectively). In the year following index ED visit, 846 first crashes occurred in the syncope group and 3457 first crashes occurred in the control group, indicating no significant difference in subsequent MVC risk (9.2% vs 10.1%; adjusted hazard ratio [aHR], 0.93; 95% CI, 0.87-1.01; P = .07). Subsequent crash risk among patients with syncope was not significantly increased in the first 30 days after index ED visit (aHR, 1.07; 95% CI, 0.84-1.36; P = .56) or among subgroups at higher risk of adverse events after syncope (eg, age >65 years; cardiogenic syncope; Canadian Syncope Risk Score Ն1). CONCLUSIONS AND RELEVANCEThe findings of this population-based retrospective cohort study suggest that patients visiting the ED with first-episode syncope exhibit a subsequent crash risk no different than the average ED patient. More stringent driving restrictions after syncope may not be warranted.

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A Systematic Review of the Risk of Motor Vehicle Collision in Patients With Syncope

Cited by 9 publications

References 24 publications

Syncope and subsequent traffic crash: A responsibility analysis

Syncope and subsequent traffic crash: A responsibility analysis

Multivariable risk scores for predicting short‐term outcomes for emergency department patients with unexplained syncope: A systematic review

Syncope and the Risk of Subsequent Motor Vehicle Crash

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