CHARACTERISTICS OF DRIVERS AND DRIVING RECORD AFTER TRAUMATIC AND NONTRAUMATIC BRAIN INJURY

Objective: To determine whether individuals with a traumatic brain inj ury (TBI) or stroke (cerebrovascular accident [CVA]) have an increased risk of subsequent motor vehicle crash or moving violation. Design: A retrospective study comparing the driving records of four cohorts hos pitalized with TBI, CVA, isolated extremity fractures (FX), and append icitis (APPY) with the records of four age-matched, gender-matched, an d zip code-matched nonhospitalized cohorts. Setting: Eligible drivers in the state of Washington, 1991 to 1993. Participants/Methods: Four c ohorts hospitalized in 1992 with TBI, CVA, FX, or APPY were identified from Washington state hospital discharge data. The state driver's lic ense database identified patients with drivers' licenses. Each hospita lized cohort was compared with its own age-matched, gender-matched, an d zip code-matched nonhospitalized cohort. Main Outcome Measures: Cras hes and citations for moving violations 12 months after hospitalizatio n adjusted for age, gender, and prior driving record. Results: The rel ative risks (RRs) of any subsequent crash or receipt of citation were not greater for those with either CVA or TBI than for nonhospitalized individuals, nor were the risks of experiencing two or more of these e vents in the 12 months after hospitalization significantly elevated. A fter adjustment for prior driving record, modest elevations were obser ved only for the risks of subsequent driving violation among those wit h TBI (RR = 1.3, 1.0-1.7) and among patients with FX (RR = 1.2, 1.1-1. 4). Conclusions: The results do not support the hypothesis that indivi duals who have sustained a brain injury are at increased risk of motor vehicle crashes. Although patients with TBI were more likely to subse quently receive citations than nonhospitalized individuals, a similar increase was observed among patients without brain injury who had FX, suggesting an inability to completely control for driver characteristi cs that may be related to risk-taking behavior and that are also assoc iated with an increased risk of driving violation. (C)1998 by the Amer ican Congress of Rehabilitation Medicine and the American Academy of P hysical Medicine and Rehabilitation.