Predictors of driving outcome after traumatic brain injury

Objective: To examine predictors of driving status and fitness to drive after traumatic brain injury (TBI). Design: Retrospective and prospective follow-up of a cohort ranging from 4 months to 10 years post-TBI. Setting: A Midwestern, urban university-affiliated rehabilitation hospital. Participants: Seventy-one pairs of adults who had sustained a TBI and their significant others. Interventions: Not applicable. Main Outcome Measures: Driving status (whether the patient resumed driving), driving frequency (estimated miles driven per week), and postinjury driving records compiled by the Department of Motor Vehicles. Results: Logistic and hierarchical regression analyses indicated that the significant other's perceptions of the patient's fitness to drive were the strongest predictor of patients' driving status and driving frequency. However, years postinjury, disability at discharge, and current neuropsychologic functioning best predicted postinjury driving safety as measured by actual incidents. The relation between perception of patients' fitness and actual driving incidents, however, was modest. Conclusions: Neuropsychologic and medical information available by traditional methods showed unique value in predictive driving safety. However, caregiver perception of patients' fitness was the overwhelming determinant of whether and how much patients drive. The bases on which caregivers form their opinions affect the safety of patients and the public. The rehabilitation setting is a unique resource for family education regarding abilities essential to safe driving.