UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA.
Department of Kinesiology, University of Georgia, Athens, Georgia, USA.
Am J Sports Med. 2023 Aug;51(10):2732-2739. doi: 10.1177/03635465231184390. Epub 2023 Jul 18.
Current medical practices and recommendations largely ignore the safety of postconcussion driving, even though commonly used measures of neurocognition, balance, and vestibulo-ocular function show impairment.
To compare simulated driving between patients with concussion and controls throughout concussion recovery using a case-control design.
Cohort study; Level of evidence, 2.
A total of 26 concussed and 23 control Division I collegiate athletes completed a driving simulation assessment at 3 time points (within 72 hours, asymptomatic, and return to sport). Cumulative driving simulation outcome variables included total number of collisions, speed exceedances, stop signs missed, lane excursions, total drive time, percentage of time over the speed limit, and percentage of time out of the lane. The mean speed, standard deviation of speed (SDS), lateral lane position, and standard deviation of lateral lane position (SDLP) were examined for each of the 11 drive segments. Outcomes were compared using generalized linear mixed models with random intercepts by participant with Poisson or normal distributions.
Within 72 hours of injury, the concussion group committed more lane excursions (median difference, 2; = .003), exhibited greater SDS while avoiding a child pedestrian crossing the road (Cohen = 0.73; = .011), drove 7 inches (18 cm) closer to the centerline during a residential left curve ( = 0.90; = .015), and had greater SDLP while navigating around a car crash compared with controls ( = 0.72; = .016). When asymptomatic, the concussion group committed fewer speed exceedances (median difference, 2; = .002) and had lower SDLP while navigating through a traffic light compared with controls ( = 0.60; = .045). No differences were evident at return to sport. Groups did not differ in total collisions at any time point.
The concussion group showed more impaired driving patterns within 72 hours of injury, drove more conservatively once asymptomatic, and had similar driving performance at the time they returned fully to sport. Clinicians should consider these findings when discussing driving with patients acutely after concussion. Further research is needed to determine whether on-road collision risk is elevated after concussion.
目前的医疗实践和建议在很大程度上忽略了脑震荡后驾驶的安全性，尽管常用的神经认知、平衡和前庭眼功能测量显示存在损伤。
采用病例对照设计，比较脑震荡患者和对照组在脑震荡恢复过程中的模拟驾驶。
队列研究；证据水平，2 级。
共有 26 名患有脑震荡和 23 名对照组的一级大学运动员在 3 个时间点（72 小时内、无症状和重返运动）完成了驾驶模拟评估。累积驾驶模拟结果变量包括碰撞总数、超速次数、错过停车标志次数、车道偏离次数、总驾驶时间、超速时间百分比和偏离车道时间百分比。分析了 11 个驾驶段的平均速度、速度标准差（SDS）、横向车道位置和横向车道位置标准差（SDLP）。使用具有参与者随机截距的广义线性混合模型，对泊松或正态分布进行比较。
在受伤后 72 小时内，脑震荡组的车道偏离次数更多（中位数差异为 2； =.003），在避免儿童行人穿过马路时 SDS 更大（Cohen = 0.73； =.011），在住宅左弯道时更靠近中心线行驶约 7 英寸（18 厘米）（ = 0.90； =.015），在绕过车祸时 SDLP 更大（ = 0.72； =.016）。当无症状时，脑震荡组超速次数更少（中位数差异为 2； =.002），在通过交通灯时 SDLP 更低（ = 0.60； =.045）。在重返运动时没有差异。在任何时间点，两组的总碰撞次数均无差异。
脑震荡组在受伤后 72 小时内表现出更明显的驾驶模式受损，一旦无症状则驾驶更保守，在完全恢复运动时驾驶表现相似。临床医生在脑震荡后急性讨论驾驶时应考虑这些发现。需要进一步研究以确定脑震荡后道路碰撞风险是否升高。
