Nguyen Henry H, Swain Mark G, Wong Philip, Congly Stephen E
University of Calgary Liver Unit, Department of Medicine (Nguyen, Swain, Congly), Division of Gastroenterology and Hepatology, Calgary, Alta.; McGill University Health Centre (Wong), Royal Victoria Hospital, Montréal, Que.
CMAJ Open. 2018 Dec 3;6(4):E575-E579. doi: 10.9778/cmajo.20180024. Print 2018 Oct-Dec.
Hepatic encephalopathy, a form of brain dysfunction seen in the setting of liver insufficiency, negatively affects driving performance and so is both a patient and public safety issue. We aimed to review the motor vehicle codes in each Canadian province and territory relating to the reporting of patients with hepatic encephalopathy and to search a Canadian legal database for cases of motor vehicle collisions involving patients with hepatic encephalopathy.
In this descriptive analysis, the transportation agencies of each Canadian province and territory were contacted via telephone and/or email between April and August 2017. Requirements of physicians to report medical conditions (including liver disease and hepatic encephalopathy) affecting a patient's fitness to drive were assessed. WestlawNext Canada was searched for any Canadian cases on hepatic encephalopathy and driving-related lawsuits from inception to Dec. 31, 2017.
Reporting of medically unfit drivers is a requirement in all Canadian provinces and territories except Alberta, Quebec and Nova Scotia. Hepatic encephalopathy, cirrhosis and advanced liver disease were not specifically identified as reportable medical conditions in any province or territory. Our search did not identify any lawsuits involving a motor vehicle collision in Canada that were made either against physicians caring for patients with hepatic encephalopathy or against such patients themselves.
Although hepatic encephalopathy has a substantial impact on driving performance, it is not specifically identified as a reportable medical condition in Canada. Increasing awareness of the potential impact of hepatic encephalopathy on safe driving for health care providers and the public is critical.
肝性脑病是肝功能不全时出现的一种脑功能障碍形式，对驾驶表现有负面影响，因此既是患者安全问题，也是公共安全问题。我们旨在审查加拿大每个省和地区与肝性脑病患者报告相关的机动车法规，并在加拿大法律数据库中搜索涉及肝性脑病患者的机动车碰撞案件。
在这项描述性分析中，2017年4月至8月期间通过电话和/或电子邮件联系了加拿大每个省和地区的运输机构。评估了医生报告影响患者驾驶适宜性的医疗状况（包括肝病和肝性脑病）的要求。在WestlawNext Canada数据库中搜索了从数据库建立到2017年12月31日期间加拿大所有关于肝性脑病及与驾驶相关诉讼的案例。
除艾伯塔省、魁北克省和新斯科舍省外，加拿大所有省和地区都要求报告不适合驾驶的医疗人员。在任何省或地区，肝性脑病、肝硬化和晚期肝病均未被明确列为应报告的医疗状况。我们的搜索未发现加拿大有任何涉及机动车碰撞的诉讼，这些诉讼是针对照顾肝性脑病患者的医生或此类患者本人提出的。
尽管肝性脑病对驾驶表现有重大影响，但在加拿大它并未被明确列为应报告的医疗状况。提高医疗保健提供者和公众对肝性脑病对安全驾驶潜在影响的认识至关重要。
