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Citation
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Tandon P, Pidborochynski T, Abraldes JG, Carbonneau M, Newnham K, Bailey R, Ismond KP, Bajaj JS, Dobbs B. Am. J. Gastroenterol. 2022; ePub(ePub): ePub. |
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Abstract
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INTRODUCTION: The association between cirrhosis and driving performance is of particular clinical relevance due to the life-threatening safety issues both for the driver with cirrhosis and the general public. Study aims were to assess: i) driving competency through the use of an in-office computerized battery and on-road driving assessment (DriveABLE™), and ii) the association between minimal hepatic encephalopathy (MHE), in-office paper-pencil tools and additional measures (e.g., frailty, depression, cognitive testing) with unsafe driving.
METHODS: Patients were prospectively recruited from two tertiary care liver clinics. In-office tests and in-office and on-road assessments of driving competence were completed. Chi-squared and one-way analysis of variance were used to analyze differences among those with and without MHE. Logistic regression was used to evaluate predictors of an indeterminate/fail result on the in-office computerized driving assessment battery (DriveABLE Cognitive Assessment Tool [DCAT]).
RESULTS: Eighty patients participated with a mean age of 57 years, 70% male, 75% Child-Pugh B/C, 36% with history of overt hepatic encephalopathy (HE). Thirty percent met MHE criteria on both the Psychometric Hepatic Encephalopathy Score (PHES) and Stroop-app tests. Only two patients (3%) were categorized as "unfit-to-drive" on the on-road driving test, one with MHE and the other without. Fifty-eight percent of the patients scored as indeterminate/fail on the DCAT. This corresponded to a higher mean number of on-road driving errors (5.3 (SD 2.1) vs 4.2 (SD 1.6) in those who passed the DCAT, p=0.01). Older age (OR 1.3; CI 1.1, 1.5; p=0.001) and MHE by Stroop/PHES (OR 11.0; CI 2.3, 51.8; p=0.002) were independently predictive of worse performance on the DCAT.
CONCLUSIONS: Worse performance on in-office testing was associated with worse scores on a computerized driving assessment battery and more on-road driving errors, but in-office tools were insufficient to predict on-road driving failures. A diagnosis of MHE should not be used alone to restrict driving in patients with cirrhosis. At-risk patients require on-road driving tests under the supervision of driving regulatory agencies. Future studies should continue to refine and evaluate in-office or at-home testing to predict driving performance.
Language: en |