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Yang J, Stavrinos D, Kerwin T, Mrug S, Tiso M, McManus B, Wrabel CG, Rundus C, Zhang F, Davis D, Swanson EM, Bentley B, Yeates KO. R2DRV: study protocol for longitudinal assessment of driving after mild TBI in young drivers. Inj Epidemiol 2024; 11:10. [PMID: 38481266 PMCID: PMC10935843 DOI: 10.1186/s40621-024-00493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) and traffic-related injuries are two major public health problems disproportionately affecting young people. Young drivers, whose driving skills are still developing, are particularly vulnerable to impaired driving due to brain injuries. Despite this, there is a paucity of research on how mTBI impacts driving and when it is safe to return to drive after an mTBI. This paper describes the protocol of the study, R2DRV, Longitudinal Assessment of Driving After Mild TBI in Young Drivers, which examines the trajectory of simulated driving performance and self-reported driving behaviors from acutely post-injury to symptom resolution among young drivers with mTBI compared to matched healthy drivers. Additionally, this study investigates the associations of acute post-injury neurocognitive function and cognitive load with driving among young drivers with and without mTBI. METHODS A total of 200 young drivers (ages 16 to 24) are enrolled from two study sites, including 100 (50 per site) with a physician-confirmed isolated mTBI, along with 100 (50 per site) healthy drivers without a history of TBI matched 1:1 for age, sex, driving experience, and athlete status. The study assesses primary driving outcomes using two approaches: (1) high-fidelity driving simulators to evaluate driving performance across four experimental study conditions at multiple time points (within 96 h of injury and weekly until symptom resolution or 8 weeks post-injury); (2) daily self-report surveys on real-world driving behaviors completed by all participants. DISCUSSION This study will fill critical knowledge gaps by longitudinally assessing driving performance and behaviors in young drivers with mTBI, as compared to matched healthy drivers, from acutely post-injury to symptom resolution. The research strategy enables evaluating how increased cognitive load may exacerbate the effects of mTBI on driving, and how post-mTBI neurocognitive deficits may impact the driving ability of young drivers. Findings will be shared through scientific conferences, peer-reviewed journals, and media outreach to care providers and the public.
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Affiliation(s)
- Jingzhen Yang
- Center for Injury Research and Policy at the Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA.
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
| | - Despina Stavrinos
- Institute for Social Science Research, The University of Alabama, ISSR 107, Box 870216, Tuscaloosa, AL, 35487, USA.
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Thomas Kerwin
- The Ohio State University Driving Simulation Laboratory, Columbus, OH, USA
| | - Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael Tiso
- Department of Sports Medicine, The Ohio State University, Columbus, OH, USA
| | - Benjamin McManus
- Institute for Social Science Research, The University of Alabama, ISSR 107, Box 870216, Tuscaloosa, AL, 35487, USA
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cameron G Wrabel
- The Ohio State University Driving Simulation Laboratory, Columbus, OH, USA
| | - Christopher Rundus
- Center for Injury Research and Policy at the Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA
| | - Fangda Zhang
- Center for Injury Research and Policy at the Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA
| | - Drew Davis
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin M Swanson
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brett Bentley
- Department of Family, Internal, and Rural Medicine, The University of Alabama, Tuscaloosa, AL, USA
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Müller Fiedler A, Almeida T, Vasconcellos FDN, Morell A, de Monaco BA, Anghinah R, Cordeiro JG. Fitness-to-drive after adult civilian traumatic brain injury: protocol for a systematic review and meta-analysis. Neurosurg Rev 2023; 46:324. [PMID: 38048009 DOI: 10.1007/s10143-023-02228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
Traumatic brain injury (TBI) poses significant challenges for assessing fitness-to-drive (FTD) and determining the appropriate timing for return-to-driving (RTD) in civilian adults. This systematic review and meta-analysis protocol is designed to offer a comprehensive assessment of RTD timelines post-TBI, examining the effects of injury severity as well as demographic and clinical factors that influence driving capabilities. In response to gaps identified in previous literature-namely, the absence of recent systematic search strategies and thorough quality assessments-this study employs rigorous methodologies for literature search, data extraction, and evaluation of study quality. Our approach aims to provide reliable estimates and detailed analyses of subgroups within the TBI population. The findings aim to support clinical decision-making, inform RTD readiness, and potentially impact policy and driving assessment protocols. Ultimately, this review seeks to contribute to public safety measures, reduce traffic-related harm, and improve life outcomes for individuals recovering from TBI, thereby filling a vital research niche in neurotrauma rehabilitation.
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Affiliation(s)
| | - Timoteo Almeida
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, USA
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Fernando De Nigris Vasconcellos
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, USA
- Department of Neurological Surgery, University of Texas Health Science, McGovern Medical School, Houston, TX, USA
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, USA
| | - Bernardo Assumpção de Monaco
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, USA
- Department of Neurology, Neurosurgery Division, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Renato Anghinah
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, USA
- Department of Neurology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
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Patrick KE, Kroshus E, Boyle LN, Wang J, Binjolkar M, Ebel BE, Rivara FP. Driving characteristics of young adults prior to and following concussion. TRAFFIC INJURY PREVENTION 2023; 25:14-19. [PMID: 37728546 PMCID: PMC10872858 DOI: 10.1080/15389588.2023.2250493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES This study sought to examine whether young adults who sustain concussions have different driving histories and pre-injury driving styles than uninjured peers. In addition, we assessed whether modifications were made to driving behavior in the acute period following concussion. METHODS Self-reported driving and demographic information was collected from 102 16- to 25-year-old drivers. Half of the sample had recently sustained concussions and the other half comprised a matched comparison group. RESULTS The groups reported similar pre-injury driving behaviors and styles. However, the recently injured group had more driving citations, higher rates of psychiatric disorders, and greater likelihood of having sustained a prior concussion. Self-reported driving habits postconcussion suggested that most drivers did not modify their driving behavior following concussion, though they were less likely to drive at night or with others in the car. CONCLUSION Results highlight the need for postconcussion driving guidelines and support for returning to driving safely.
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Affiliation(s)
- Kristina E Patrick
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington
- Department of Neurosciences, Seattle Children's Hospital, Seattle, Washington
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Emily Kroshus
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Linda Ng Boyle
- Department of Industrial & Systems Engineering, University of Washington, Seattle, Washington
- Department of Civil & Environmental Engineering, University of Washington, Seattle, Washington
| | - Jin Wang
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- The Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Mayuree Binjolkar
- Department of Civil & Environmental Engineering, University of Washington, Seattle, Washington
| | - Beth E Ebel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
- The Harborview Injury Prevention and Research Center, Seattle, Washington
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Frederick P Rivara
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
- The Harborview Injury Prevention and Research Center, Seattle, Washington
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
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Schmidt JD, Lynall RC, Lempke LB, Miller LS, Gore RK, Devos H. Longitudinal Assessment of Postconcussion Driving: Evidence of Acute Driving Impairment. Am J Sports Med 2023; 51:2732-2739. [PMID: 37462687 DOI: 10.1177/03635465231184390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Current medical practices and recommendations largely ignore the safety of postconcussion driving, even though commonly used measures of neurocognition, balance, and vestibulo-ocular function show impairment. PURPOSE To compare simulated driving between patients with concussion and controls throughout concussion recovery using a case-control design. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 26 concussed and 23 control Division I collegiate athletes completed a driving simulation assessment at 3 time points (within 72 hours, asymptomatic, and return to sport). Cumulative driving simulation outcome variables included total number of collisions, speed exceedances, stop signs missed, lane excursions, total drive time, percentage of time over the speed limit, and percentage of time out of the lane. The mean speed, standard deviation of speed (SDS), lateral lane position, and standard deviation of lateral lane position (SDLP) were examined for each of the 11 drive segments. Outcomes were compared using generalized linear mixed models with random intercepts by participant with Poisson or normal distributions. RESULTS Within 72 hours of injury, the concussion group committed more lane excursions (median difference, 2; P = .003), exhibited greater SDS while avoiding a child pedestrian crossing the road (Cohen d = 0.73; P = .011), drove ~7 inches (~18 cm) closer to the centerline during a residential left curve (d = 0.90; P = .015), and had greater SDLP while navigating around a car crash compared with controls (d = 0.72; P = .016). When asymptomatic, the concussion group committed fewer speed exceedances (median difference, 2; P = .002) and had lower SDLP while navigating through a traffic light compared with controls (d = 0.60; P = .045). No differences were evident at return to sport. Groups did not differ in total collisions at any time point. CONCLUSION The concussion group showed more impaired driving patterns within 72 hours of injury, drove more conservatively once asymptomatic, and had similar driving performance at the time they returned fully to sport. Clinicians should consider these findings when discussing driving with patients acutely after concussion. Further research is needed to determine whether on-road collision risk is elevated after concussion.
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Affiliation(s)
- Julianne D Schmidt
- UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Landon B Lempke
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Russell K Gore
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, USA
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