The 4Cs (crash history, family concerns, clinical condition, and cognitive functions): a screening tool for the evaluation of the at-risk driver.

OBJECTIVES

To evaluate the effectiveness of crash history, family concerns, clinical condition, and cognitive function (the 4Cs, an interview-based screening tool for health providers working with older drivers) in identifying at-risk older drivers.

DESIGN

Retrospective cohort study.

SETTING

Clinical driving evaluation program at a teaching hospital in the United States.

PARTICIPANTS

One hundred sixty patients who completed comprehensive driving evaluations between 2003 and 2009.

MEASUREMENTS

Medical record information was used to identify component and total 4Cs scores. Other measurements included the Trail Making Test, the Mini-Mental State Examination, and brake reaction time. The outcome variable was performance on a 45-minute road test.

RESULTS

Fifty participants passed the road test, 67 failed, and 43 demonstrated marginal driving skills. The relationship between 4Cs scores and road test outcome was statistically significant (P<.001). The domains most strongly associated with road test outcome were cognitive function (P<.001) and family concerns (P=.01). Scores of 9 or greater-on the 4Cs identified 84% of participants who were at risk for poor road test performance.

CONCLUSION

The 4Cs, an interview based screening tool, may be a useful marker to identify at-risk older drivers.