Delirium and Self-Reported Driving Behaviors and Outcomes After Critical Illness.

IMPORTANCE

Survivors of critical illness often have ongoing issues that affect functioning, including driving ability.

OBJECTIVE

To examine whether intensive care unit (ICU) delirium is independently associated with long-term changes in driving behaviors.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, longitudinal cohort study included 151 survivors of critical illness residing within 200 miles of Nashville, Tennessee. Survivors were surveyed 2 to 6 years after critical illness to assess the association between delirium duration and driving skills and behaviors (July 1, 2012, to April 30, 2013), and data were analyzed in 2014.

MAIN OUTCOMES AND MEASURES

The primary and secondary outcomes were self-rated driving skill (Driver Skill Inventory) and risky driving behaviors (Mini Driver Behavior Questionnaire), respectively. Exploratory outcomes included changes in driving decisions and driving-related attitudes.

RESULTS

Of 333 survivors from the original study, 151 (45.3%) were active drivers and agreed to participation at a median (range) of 3.7 (2.1-6.2) years after critical illness (median [IQR] age at enrollment, 59 [50-64] years; 87 [57.6%] male) with a median (IQR) delirium duration of 1 (0-4) day. Driving resumption occurred at a median (IQR) of 1.9 (0.8-6.0) months after ICU discharge. Delirium duration was not independently associated with self-rated driving skill or risky driving behavior measures (regression coefficients of -0.10 [95% CI, -1.13 to 0.93] for Driver Skill Inventory and-0.46 [95% CI, -1.97 to 1.06] for Mini Driver Behavior Questionnaire). Driving distances after critical illness were significantly lower than prehospitalization estimates (median [IQR], 60 [25-150] vs 105 [58-250] miles per week; P < .001). Driving skill (median [IQR], 34 [26-38] on a 48-point scale; P < .001) and safety orientation measures (median [IQR], 38 [35-46] on a 48-point scale; P < .001) were significantly lower upon return to driving. These decrements persisted among adults 65 years and older.

CONCLUSIONS AND RELEVANCE

In this cohort study of survivors of critical illness, ICU delirium was not independently associated with long-term changes in driving behaviors after critical illness; survivors of critical illness self-reported significant decreases in transportation independence and driving skill after hospital discharge, independent of delirium duration during hospitalization. These results suggest that clinicians should consider transportation-related limitations relevant to short- and long-term care planning.