(791) Driving Status After Acute and Critical Illness: A Systematic Review

Introduction: Adults recovering from hospitalization for acute or critical illnesses often face new or worsening physical and cognitive impairments, which can impact their driving abilities and safety. This systematic review synthesizes evidence on driving behaviors and outcomes in the six months following hospitalization for acute or critical illness, aiming to guide patient care, provider recommendations, and future research.

Methods: A comprehensive search was conducted on PubMed, CINAHL, PsycINFO, and Cochrane databases from 1997 to October 20, 2023. Quantitative and qualitative studies involving vehicle drivers were included. Studies were excluded if they focused on medical conditions with established driving rehabilitation programs (e.g., stroke). Systematic review procedures were pre-registered in PROSPERO (CRD42023464876). Two authors screened the papers, extracted the data independently and evaluated the risk of bias using the CASP Tool.

Results: Out of 2,378 studies, 19 studies met inclusion criteria representing 513 hospitalized adults. Driving behavior and safety data were derived from simulators (n=10) and self-reports (n=9) with none using in-vehicle sensors of on-road driving. Prevalence rates included reports of driving resumption at 1-month (13%), 3 months (68%), 6 months (77%), and 1-year (84%). Simulation studies primarily focused on post-surgical populations and brake reaction times. Pooled analysis of brake reaction times showed slower reaction times compared with driving standards. Self-report studies highlighted driving cessation, and perceived safety issues.

Conclusions: The evidence on driving safety and behavior post-hospitalization is mixed, with some studies indicating no significant change in collision rates and others showing increased risks. We found that while in-vehicle kinematic sensor-based analyses have been employed to examine driving safety for people living with dementia, seizure disorders, and other chronic conditions, there are no kinematic sensor-based studies examining driving safety after acute/critical illness. This synthesis offers summary information relevant to developing evidence-based guidelines to enhance patient safety, inform clinical practice and standardize post-hospitalization driving assessments.