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Risk of Motor Vehicle Collision or Driving Impairment After Traumatic Brain Injury

A Collaborative International Systematic Review and Meta-Analysis

Chee, Justin N., MSc; Hawley, Carol, PhD; Charlton, Judith L., PhD; Marshall, Shawn, MD; Gillespie, Ian, MD; Koppel, Sjaan, PhD; Vrkljan, Brenda, PhD; Ayotte, Debbie, MLIS; Rapoport, Mark J., MD

The Journal of Head Trauma Rehabilitation: January/February 2019 - Volume 34 - Issue 1 - p E27–E38
doi: 10.1097/HTR.0000000000000400
Focus on Clinical Research and Practice

Objective: To synthesize knowledge of the risk of motor vehicle collision (MVC) following a traumatic brain injury (TBI) and the associated risk of driving impairment, as measured by on-road tests, computerized simulators, and self-reported or state-recorded driving records.

Methods: Our international team searched 7 databases for studies published between 1990 and 2015 of people with TBI, controls, and data concerning either MVC or driving impairment. The included articles examined the risk of MVC among people with TBI; we excluded studies that examined the risk of having a TBI associated with being involved in an MVC.

Results: From 13 578 search results, we included 8 studies involving 1663 participants with TBI and 4796 controls. We found no significant difference in the risk of MVC (odds ratio = 1.24, 95% confidence interval = 0.80-1.91, P = .34). When we restricted the analysis to self-report, the risk of MVC was higher for those without a TBI (odds ratio = 1.63, 95% confidence interval = 1.21-2.22, P = .002). In contrast, participants with TBI consistently performed worse during on-road assessments and had more problems with vehicular control.

Conclusion: Limitations of reviewed studies included small sample sizes, failure to specify TBI severity or time postinjury, and absence of objective measures of risk. Findings concerning the relationship between TBIs from non-MVC causes and crash risk are, therefore, inconclusive and do not provide evidence for major changes to existing clinical guidelines for driving with TBI.

Department of Psychiatry, Sunnybrook Health Sciences Centre, and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Mr Chee and Dr Rapoport); Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK (Dr Hawley); Monash University Accident Research Centre, Monash University, Clayton, Australia (Drs Charlton and Koppel); Ottawa Hospital Research Institute, Ontario, Canada (Dr Marshall); Canadian Forces Health Services Centre (Pacific), Victoria, British Columbia, Canada (Dr Gillespie); School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada (Dr Vrkljan); and Canadian Medical Association, Ottawa, Ontario, Canada (Ms Ayotte).

Corresponding Author: Justin N. Chee, MSc, Evaluative Clinical Sciences, Sunnybrook Research Institute, Room F111, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada (

Special thanks to Regina McFadden, Dr Frank Molnar, Dr Krista Lanctöt, Dr Gary Naglie, and Dr Jeff Blackmer for their participation in the topic ranking survey.

All authors contributed to study design, data collection, data analysis, data interpretation, and writing the article (C.H., J.L.C., S.M., I.G., S.K., B.V., D.A., J.N.C., and M.J.R.). The literature search was performed by D.A. Tables and figures were prepared by J.N.C. and M.J.R.

PROSPERO International prospective register of systematic reviews (CRD42016039015).

This knowledge synthesis was funded by the Canadian Institutes of Health Research (CIHR) (KRS grant #339665). The funders played no role in the study methodology, interpretation of results, preparation of the report, or the process of disseminating this work. They accept no responsibility for the contents.

Mr Chee, Drs Hawley, Marshall, Koppel, and Vrkljan, and Ms Ayotte have nothing to disclose. Dr Charlton reports grants from Victorian Government Transport Accident Commission, the other from BrainLink, the other from Royal College of Physicians of Ireland, and the other from National Transportation Commission, during the conduct of the study. Dr Gillespie reports personal fees from Consultancy to Canadian Medical Association, personal fees from Consultancy to RoadSafetyBC, and personal fees from Expert testimony on traumatic brain injury, outside the submitted work. Dr Rapoport reports grants from CIHR (KRS grant #339665), during the conduct of the study; personal fees from Canadian Medical Association, outside the submitted work; and serving as board president of the Canadian Academy of Geriatric Psychiatry.

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The authors declare no conflicts of interest.

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