Syncope and Motor Vehicle Crash Risk: A Danish Nationwide Study

TY - JOUR

T1 - Syncope and Motor Vehicle Crash Risk

T2 - A Danish Nationwide Study

AU - Numé, Anna-Karin

AU - Gislason, Gunnar

AU - Christiansen, Christine Benn

AU - Zahir, Deewa

AU - Hlatky, Mark A

AU - Torp-Pedersen, Christian

AU - Ruwald, Martin Huth

PY - 2016/4

Y1 - 2016/4

N2 - IMPORTANCE: Syncope may have serious consequences for traffic safety. Current clinical guideline recommendations on driving following syncope are primarily based on expert consensus.OBJECTIVE: To identify whether there is excess risk of motor vehicle crashes among patients with syncope compared with the general population.DESIGN, SETTING, AND PARTICIPANTS: Danish nationwide cohort study from January 1, 2008, to December 31, 2012. Through individual-level linkage of nationwide administrative registers, all Danish residents 18 years or older were identified. Of 4 265 301 eligible Danish residents, we identified 41 039 individuals with a first-time diagnosis of syncope from emergency department or hospital.MAIN OUTCOMES AND MEASURES: Rate of motor vehicle crashes (including nonfatal and fatal crashes), based on multivariate Poisson regression models, using the total Danish population as reference.RESULTS: The 41 039 patients with syncope had a median age of 66 years (interquartile range [IQR], 47-78 years); 51.0% were women; and 34.8% had cardiovascular disease. Through a median follow-up of 2.0 years (IQR, 0.8-3.3 years), 1791 patients with syncope (4.4%) had a motor vehicle crash, 78.1% of which led to injury (n = 1398) and 0.3% to death (n = 6). The crude incidence rate of motor vehicle crashes was almost doubled among patients with syncope (20.6 per 1000 person-years; 95% CI, 19.7-21.6) compared with the general population (12.1; 95% CI, 12.0-12.1), with a rate ratio (RR) of 1.83 (95% CI, 1.74-1.91) after adjustment for age, sex, socioeconomic position, and relevant comorbidities and pharmacotherapy. Men had a relatively higher rate of motor vehicle crashes (RR, 1.91; 95% CI, 1.79-2.03) than women (RR, 1.74; 95% CI, 1.63-1.87). The excess risk of motor vehicle crashes persisted throughout the follow-up period. The 5-year crash risk following syncope was 8.2% (95% CI, 7.5%-8.8%) among the population aged 18 to 69 years compared with 5.1% (95% CI, 4.7%-5.4%) in the general population.CONCLUSIONS AND RELEVANCE: Prior hospitalization for syncope was associated with increased risk of motor vehicle crashes throughout the follow-up period. This study suggests that syncope should be considered as one of several factors in a broad assessment of fitness to drive.

AB - IMPORTANCE: Syncope may have serious consequences for traffic safety. Current clinical guideline recommendations on driving following syncope are primarily based on expert consensus.OBJECTIVE: To identify whether there is excess risk of motor vehicle crashes among patients with syncope compared with the general population.DESIGN, SETTING, AND PARTICIPANTS: Danish nationwide cohort study from January 1, 2008, to December 31, 2012. Through individual-level linkage of nationwide administrative registers, all Danish residents 18 years or older were identified. Of 4 265 301 eligible Danish residents, we identified 41 039 individuals with a first-time diagnosis of syncope from emergency department or hospital.MAIN OUTCOMES AND MEASURES: Rate of motor vehicle crashes (including nonfatal and fatal crashes), based on multivariate Poisson regression models, using the total Danish population as reference.RESULTS: The 41 039 patients with syncope had a median age of 66 years (interquartile range [IQR], 47-78 years); 51.0% were women; and 34.8% had cardiovascular disease. Through a median follow-up of 2.0 years (IQR, 0.8-3.3 years), 1791 patients with syncope (4.4%) had a motor vehicle crash, 78.1% of which led to injury (n = 1398) and 0.3% to death (n = 6). The crude incidence rate of motor vehicle crashes was almost doubled among patients with syncope (20.6 per 1000 person-years; 95% CI, 19.7-21.6) compared with the general population (12.1; 95% CI, 12.0-12.1), with a rate ratio (RR) of 1.83 (95% CI, 1.74-1.91) after adjustment for age, sex, socioeconomic position, and relevant comorbidities and pharmacotherapy. Men had a relatively higher rate of motor vehicle crashes (RR, 1.91; 95% CI, 1.79-2.03) than women (RR, 1.74; 95% CI, 1.63-1.87). The excess risk of motor vehicle crashes persisted throughout the follow-up period. The 5-year crash risk following syncope was 8.2% (95% CI, 7.5%-8.8%) among the population aged 18 to 69 years compared with 5.1% (95% CI, 4.7%-5.4%) in the general population.CONCLUSIONS AND RELEVANCE: Prior hospitalization for syncope was associated with increased risk of motor vehicle crashes throughout the follow-up period. This study suggests that syncope should be considered as one of several factors in a broad assessment of fitness to drive.

KW - Accidents, Traffic

KW - Adolescent

KW - Adult

KW - Aged

KW - Cohort Studies

KW - Denmark

KW - Female

KW - Humans

KW - Information Storage and Retrieval

KW - Male

KW - Middle Aged

KW - Registries

KW - Risk

KW - Syncope

KW - Young Adult

KW - Journal Article

KW - Observational Study

KW - Research Support, Non-U.S. Gov't

U2 - 10.1001/jamainternmed.2015.8606

DO - 10.1001/jamainternmed.2015.8606

M3 - Journal article

C2 - 26927689

SN - 2168-6106

VL - 176

SP - 503

EP - 510

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

IS - 4

ER -