Returning Adolescents to Driving after Sports-Related Concussions: What Influences Physician Decision-Making

• Published in: The Journal of pediatrics Vol. 194; pp. 177 - 181
• Main Authors: MacDonald, James, Patel, Neha, Young, Julie, Stuart, Emily
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2018
• Subjects: Adolescent; Athletic Injuries - diagnosis; Automobile Driving - statistics & numerical data; BESS test; Brain Concussion - diagnosis; Clinical Decision-Making - methods; CogState; Cohort Studies; computerized neurocognitive test; Female; Humans; Male; Neuropsychological Tests - statistics & numerical data; PCSS; Physicians; reaction time; Retrospective Studies; RTD; SRC; PCSS; computerized neurocognitive test; CNT; BESS test; reaction time; CogState; EMR; BESS; mTBI
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2017.10.032

To determine which data collected on an initial patient clinic visit for a sports-related concussion (SRC) might influence physicians to clear an adolescent to return to drive (RTD) after injury. Retrospective cohort study of 189 adolescents with a SRC referred to a hospital-based concussion clinic between June 1, 2015, and May 31, 2016. Subjects were ≥16 years with a valid driver's license (median age = 16, IQR [16, 17]). Concussion evaluations included Post-Concussion Symptom Scale, modified Balance Error Scoring System, and postinjury computerized neurocognitive testing (CNT). Clearance for RTD was the main outcome. Statistical comparisons were conducted with Mann–Whitney U and χ2 tests and logistic regression. In multivariable analysis, odds of being fully cleared to drive were 5.9-fold greater among patients who were administered CNT. Stated symptoms of “headache” and “sensitivity to light” were statistically significantly associated with RTD clearance. For a subset of 113 individuals undergoing CNT, each additional 10-millisecond decrease in simple reaction time was associated with 9% greater odds of being cleared to drive. Each additional 10-millisecond decrease in choice reaction time was associated with 4% greater odds of being cleared to drive. CNT and associated reaction time measures may facilitate a physician's objective decision-making. Making a RTD determination for adolescents recovering from an SRC should be a core component of a physician's assessment.