Characteristics of drivers and driving record after traumatic and nontraumatic brain injury

Objective: To determine whether individuals with a traumatic brain injury (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 hospitalized with TBI, CVA, isolated extremity fractures (FX), and appendicitis (APPY) with the records of four age-matched, gender-matched, and zip code-matched nonhospitalized cohorts. Setting: Eligible drivers in the state of Washington, 1991 to 1993. Participants/Methods: Four cohorts hospitalized in 1992 with TBI, CVA, FX, or APPY were identified from Washington state hospital discharge data. The state driver's license database identified patients with drivers' licenses. Each hospitalized cohort was compared with its own age-matched, gender-matched, and zip code-matched nonhospitalized cohort. Main Outcome Measures: Crashes and citations for moving violations 12 months after hospitalization adjusted for age, gender, and prior driving record. Results: The relative 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 events in the 12 months after hospitalization significantly elevated. After adjustment for prior driving record, modest elevations were observed only for the risks of subsequent driving violation among those with 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 individuals who have sustained a brain injury are at increased risk of motor vehicle crashes. Although patients with TBI were more likely to subsequently 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 characteristics that may be related to risk-taking behavior and that are also associated with an increased risk of driving violation. (C)1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.