Department of Medicine, University of Toronto, Toronto, ON, Canada.
N Engl J Med. 2012 Sep 27;367(13):1228-36. doi: 10.1056/NEJMsa1114310.
Physicians' warnings to patients who are potentially unfit to drive are a medical intervention intended to prevent trauma from motor vehicle crashes. We assessed the association between medical warnings and the risk of subsequent road crashes.
We identified consecutive patients who received a medical warning in Ontario, Canada, between April 1, 2006, and December 31, 2009, from a physician who judged them to be potentially unfit to drive. We excluded patients who were younger than 18 years of age, who were not residents of Ontario, or who lacked valid health-card numbers under universal health insurance. We analyzed emergency department visits for road crashes during a baseline interval before the warning and a subsequent interval after the warning.
A total of 100,075 patients received a medical warning from a total of 6098 physicians. During the 3-year baseline interval, there were 1430 road crashes in which the patient was a driver and presented to the emergency department, as compared with 273 road crashes during the 1-year subsequent interval, representing a reduction of approximately 45% in the annual rate of crashes per 1000 patients after the warning (4.76 vs. 2.73, P<0.001). The lower rate was observed across patients with diverse characteristics. No significant change was observed in subsequent crashes in which patients were pedestrians or passengers. Medical warnings were associated with an increase in subsequent emergency department visits for depression and a decrease in return visits to the responsible physician.
Physicians' warnings to patients who are potentially unfit to drive may contribute to a decrease in subsequent trauma from road crashes, yet they may also exacerbate mood disorders and compromise the doctor-patient relationship. (Funded by the Canada Research Chairs program and others.).
医生向潜在不适合驾驶的患者发出警告，这是一种旨在预防机动车事故创伤的医疗干预措施。我们评估了医疗警告与随后道路碰撞风险之间的关联。
我们在加拿大安大略省确定了 2006 年 4 月 1 日至 2009 年 12 月 31 日期间，由于医生认为患者可能不适合驾驶而从医生那里收到医疗警告的连续患者。我们排除了年龄小于 18 岁、非安大略省居民或在全民医疗保险下缺乏有效健康卡号码的患者。我们分析了在警告前的基线间隔和警告后的后续间隔内因道路碰撞而到急诊室就诊的情况。
共有 100075 名患者从 6098 名医生那里收到了医疗警告。在 3 年的基线间隔内，有 1430 起患者为驾驶员且在急诊室就诊的道路碰撞事件，而在随后的 1 年间隔内有 273 起道路碰撞事件，这表明在警告后，每 1000 名患者的年度碰撞率降低了约 45%（4.76 与 2.73，P<0.001）。在具有不同特征的患者中均观察到较低的发生率。在患者为行人或乘客的后续碰撞中，没有观察到明显变化。随后急诊就诊的抑郁发生率增加，而负责医生的复诊率下降。
医生向潜在不适合驾驶的患者发出警告可能有助于减少随后的道路碰撞创伤，但也可能加重情绪障碍并损害医患关系。（由加拿大研究主席计划和其他组织资助）。
