Dataset Information

Predicting Risk of Motor Vehicle Collisions in Patients with Glaucoma: A Longitudinal Study.

ABSTRACT:

Purpose

To evaluate the ability of longitudinal Useful Field of View (UFOV) and simulated driving measurements to predict future occurrence of motor vehicle collision (MVC) in drivers with glaucoma.

Design

Prospective observational cohort study.

Participants

117 drivers with glaucoma followed for an average of 2.1 ± 0.5 years.

Methods

All subjects had standard automated perimetry (SAP), UFOV, driving simulator, and cognitive assessment obtained at baseline and every 6 months during follow-up. The driving simulator evaluated reaction times to high and low contrast peripheral divided attention stimuli presented while negotiating a winding country road, with central driving task performance assessed as "curve coherence". Drivers with MVC during follow-up were identified from Department of Motor Vehicle records.

Main outcome measures

Survival models were used to evaluate the ability of driving simulator and UFOV to predict MVC over time, adjusting for potential confounding factors.

Results

Mean age at baseline was 64.5 ± 12.6 years. 11 of 117 (9.4%) drivers had a MVC during follow-up. In the multivariable models, low contrast reaction time was significantly predictive of MVC, with a hazard ratio (HR) of 2.19 per 1 SD slower reaction time (95% CI, 1.30 to 3.69; P = 0.003). UFOV divided attention was also significantly predictive of MVC with a HR of 1.98 per 1 SD worse (95% CI, 1.10 to 3.57; P = 0.022). Global SAP visual field indices in the better or worse eye were not predictive of MVC. The longitudinal model including driving simulator performance was a better predictor of MVC compared to UFOV (R2 = 0.41 vs R2 = 0.18).

Conclusions

Longitudinal divided attention metrics on the UFOV test and during simulated driving were significantly predictive of risk of MVC in glaucoma patients. These findings may help improve the understanding of factors associated with driving impairment related to glaucoma.

SUBMITTER: Gracitelli CP

PROVIDER: S-EPMC4591330 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Predicting Risk of Motor Vehicle Collisions in Patients with Glaucoma: A Longitudinal Study.

Gracitelli Carolina P B CP Tatham Andrew J AJ Boer Erwin R ER Abe Ricardo Y RY Diniz-Filho Alberto A Rosen Peter N PN Medeiros Felipe A FA

PloS one 20151001 10

<h4>Purpose</h4>To evaluate the ability of longitudinal Useful Field of View (UFOV) and simulated driving measurements to predict future occurrence of motor vehicle collision (MVC) in drivers with glaucoma.<h4>Design</h4>Prospective observational cohort study.<h4>Participants</h4>117 drivers with glaucoma followed for an average of 2.1 ± 0.5 years.<h4>Methods</h4>All subjects had standard automated perimetry (SAP), UFOV, driving simulator, and cognitive assessment obtained at baseline and every ...[more]

PMID: 26426342

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Project description:PurposeTo identify the incidence rate of motor vehicle collisions (MVCs) in patients with no ocular pathology other than primary open-angle glaucoma (POAG) and determine the putative risk factors for MVCs in this group of patients.MethodsWe designed a prospective cohort study across three centers utilizing a consecutive sampling method to identify all patients with POAG between the ages of 40 and 80 years old. Patients with glaucoma were consecutively screened for eligibility. All study participants answered a questionnaire about motor vehicle collisions at baseline, and answered the questionnaire again every 12 months (± 1 month) after baseline for three years. A binocular integrated visual field was calculated for each patient by merging a patient's monocular Humphrey Field Analyzer (HFA) visual fields (VFs), using the 'best sensitivity' method. Patients with incident MVCs were defined as the "MVC+" group and patients without incident MVCs were defined as the "MVC-" group. Adjusted odds ratios for the incidence of MVCs were estimated with a logistic regression model.ResultsOne hundred and ninety-one Japanese POAG patients were analyzed in this study. The age of the participants was 63.7 ± 10.2 [mean ± standard deviation]. A total of 28 participants experienced a MVC during the follow up period of three years (4.9% per year). Ten patients (5.2%) experienced a MVC in the first year, 13 patients (6.8%) in the second year, and 11 patients (5.8%) in the third year (some patients experienced multiple MVCs over different years). Best corrected visual acuity in the worst eye was significantly worse in the MVC+ group (0.03 ± 0.01, mean ± standard deviation, LogMar) compared with the MVC- group (0.01 ± 0.003, p = 0.01), and was the only variable identified as a significant predictor of future MVCs in the multiple logistic regression model [odds ratio: 1.2, 95% confidence interval (CI): 1.1 to 1.4].ConclusionDeterioration in visual acuity in the worst eye is a risk factor for future MVCs in patients with POAG.

Project description:ObjectivePrehospital non-transport events occur when emergency medicine service (EMS) providers respond to a scene, but the patient is ultimately not transported to a hospital for evaluation. The objective of this study was to determine the rate of non-transport of pediatric patients who were involved in a motor vehicle collision (MVC) and the factors associated with non-transport decisions.MethodsWe searched the National Emergency Medical Services Information System (NEMSIS) database using ICD-10 mechanism of injury codes to identify cases in which EMS responded to a pediatric occupant (age < 18 years) who had been involved in an MVC. We excluded interfacility transports, scene assists, deaths at the scene, and collisions that occurred outside the US. The outcome of interest was if pediatric patients were not transported to a hospital for evaluation. We performed univariate and multivariate analysis to identify which risk factors were associated with non-transport. We also analyzed regional variation and the reasons recorded for not transporting patients.ResultsWe identified 92,254 pediatric patients who were evaluated by EMS after an MVC, of which 31,404 (34.0%) were not transported to a hospital for evaluation. In our adjusted analysis, the factors associated with non-transport were age <1 year or >16 years, male sex, normal Glasgow Coma Scale (GCS = 15), level of training of EMS providers, response time later than 6 a.m., and region of the country. GCS was the most important factor, with only 3.0% (108/3,616) of patients not transported who had abnormal GCS (< 15). In cases of non-transport, 32.7% (10257) were due to patient or caregiver refusal, and 33.3% (10,442) were due to patients being discharged against medical advice. Only 11.5% (3,627) pediatric patients who were not transported were discharged based on an established protocol.ConclusionsPediatric patients were not transported after EMS responded to an MVC in approximately one-third of cases, and there was considerable variation in the rate of non-transports based on geographic region, provider level, and time of day. The majority of non-transports occurred because patients were discharged against medical advice or the patient/caregiver refused transport, which may indicate conflicting priorities between EMS providers and patients.

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Dataset Information

Predicting Risk of Motor Vehicle Collisions in Patients with Glaucoma: A Longitudinal Study.

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Publications

Predicting Risk of Motor Vehicle Collisions in Patients with Glaucoma: A Longitudinal Study.

Similar Datasets

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