Syncope and Motor Vehicle Crash Risk: A Danish Nationwide Study

Anna-Karin Numé, Gunnar Gislason, Christine B Christiansen, Deewa Zahir, Mark A Hlatky, Christian Torp-Pedersen, Martin H Ruwald

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    Abstrakt

    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.

    OriginalsprogEngelsk
    TidsskriftJ A M A Internal Medicine
    Vol/bind176
    Udgave nummer4
    Sider (fra-til)503-510
    ISSN2168-6106
    DOI
    StatusUdgivet - 2016

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    Citationsformater

    Numé, A-K., Gislason, G., Christiansen, C. B., Zahir, D., Hlatky, M. A., Torp-Pedersen, C., & Ruwald, M. H. (2016). Syncope and Motor Vehicle Crash Risk: A Danish Nationwide Study. J A M A Internal Medicine, 176(4), 503-510. https://doi.org/10.1001/jamainternmed.2015.8606