急诊室中的连线测验B与驾驶员筛查

The Trail-making Test B and driver screening in the emergency department.

作者信息

Betz Marian E, Fisher Jonathan

机构信息

Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.

出版信息

Traffic Inj Prev. 2009 Oct;10(5):415-20. doi: 10.1080/15389580903132819.

DOI:10.1080/15389580903132819

PMID:19746304

Abstract

OBJECTIVES

Emergency departments (EDs) rarely screen for older driving safety. The Trail-Making Test B (TMT-B) is a neuropsychological test that may predict ability to drive. We sought to examine the driving patterns of older ED patients and the feasibility of screening patients in the ED using the TMT-B.

METHODS

At a single ED at a tertiary care center, we administered the TMT-B and a survey of health status and driving habits to a convenience sample of adult (age 18 and older) ED patients. We excluded those with altered mentation, critical illness, or language barriers. The TMT-B, scored by the time of first attempt, requires connection of letters and numbers in sequence on paper, and a time > or = 180 s may suggest elevated driving risk. We compared time to complete the TMT-B among ED patients to published norms.

RESULTS

Of 144 patients ages 18 to 95, 95 (72.2%) were current drivers, and 91.4 percent of drivers were able to complete the TMT-B; 47.1 percent of drivers were older (65+), and 88.8 percent of older drivers rated their ability as good or excellent. In multivariate logistic regression, neither TMT-B performance nor being older predicted a recent collision. The mean TMT-B completion time was 66.1 (SD = 36.3, median = 56) s among drivers under age 65 and 117.5 (SD = 79.2, median = 95) s among those 65 or older. Approximately 1.9 percent (95% CI: 0.04-10.2) of drivers under 65 and 14.0 percent (95% CI: 5.3-27.9%) of drivers 65 or older required 180 s or more for the TMT-B. Using unpaired T-tests, study TMT-B times were not significantly different from previously published norms except among 25- to 34-year-olds (79.2 versus 50.7 s; p < 0.05) and 80- to 84-year-olds (223.9 versus 146.8 s; p < 0.01).

CONCLUSIONS

Many older ED patients drive, and relatively healthy ED patients are able to complete the TMT-B with results similar to standard nomograms. The TMT-B may prove useful as part of targeted driver screening programs in EDs.

摘要

目的

急诊科很少对老年驾驶安全进行筛查。连线测验B（TMT-B）是一种神经心理学测试，可能预测驾驶能力。我们试图研究老年急诊科患者的驾驶模式，以及在急诊科使用TMT-B对患者进行筛查的可行性。

方法

在一家三级医疗中心的单一急诊科，我们对成年（18岁及以上）急诊科患者的便利样本进行了TMT-B测试，并对其健康状况和驾驶习惯进行了调查。我们排除了那些精神状态改变、患有危重病或有语言障碍的患者。TMT-B根据首次尝试的时间计分，要求在纸上按顺序连接字母和数字，时间大于或等于180秒可能表明驾驶风险升高。我们将急诊科患者完成TMT-B的时间与已发表的标准进行了比较。

结果

在144名年龄在18至95岁的患者中，95名（72.2%）为当前驾驶者，91.4%的驾驶者能够完成TMT-B；47.1%的驾驶者年龄较大（65岁及以上），88.8%的老年驾驶者将自己的能力评为良好或优秀。在多因素逻辑回归分析中，TMT-B表现和年龄较大均不能预测近期发生碰撞。65岁以下驾驶者的TMT-B平均完成时间为66.1（标准差=36.3，中位数=56）秒，65岁及以上驾驶者为117.5（标准差=79.2，中位数=95）秒。65岁以下驾驶者中约1.9%（95%置信区间：0.04-10.2）以及65岁及以上驾驶者中14.0%（95%置信区间：5.3-27.9%）完成TMT-B需要180秒或更长时间。使用非配对t检验，研究中的TMT-B时间与先前发表的标准无显著差异，但25至34岁组（79.2对50.7秒；p<0.05）和80至84岁组（223.9对146.8秒；p<0.01）除外。