Syncope and subsequent traffic crash: A responsibility analysis

Background Physicians are often asked to counsel patients about driving safety after syncope, yet little empirical data guides such advice. Methods We identified a population-based retrospective cohort of 9,507 individuals with a driver license who were discharged from any of six urban emergency departments (EDs) with a diagnosis of ‘syncope and collapse’. We examined all police-reported crashes that involved a cohort member as a driver and occurred between 1 January 2010 and 31 December 2016. We categorized crash-involved drivers as ‘responsible’ or ‘non-responsible’ for their crash using detailed police-reported crash data and a validated responsibility scoring tool. We then used logistic regression to test the hypothesis that recent syncope was associated with driver responsibility for crash. Results Over the 7-year study interval, cohort members were involved in 475 police-reported crashes: 210 drivers were deemed responsible and 133 drivers were deemed non-responsible for their crash; the 132 drivers deemed to have indeterminate responsibility were excluded from further analysis. An ED visit for syncope occurred in the three months leading up to crash in 11 crash-responsible drivers and in 5 crash-non-responsible drivers, suggesting that recent syncope was not associated with driver responsibility for crash (adjusted odds ratio, 1.31; 95%CI, 0.40-4.74; p=0.67). However, all drivers with cardiac syncope were deemed responsible, precluding calculation of an odds ratio for this important subgroup. Conclusions Recent syncope was not significantly associated with driver responsibility for traffic crash. Clinicians and policymakers should consider these results when making fitness-to-drive recommendations after syncope. Key Messages What is already known on this topic: Clinicians are often asked to counsel patients about driving safety after syncope, yet little empirical data guides such advice. What this study adds: In contrast to prior studies, we found no significant association between an emergency department visit for syncope and driver responsibility for a subsequent motor vehicle crash. How this study might affect research, practice or policy: These findings might reassure clinicians, patients and policymakers that current driving restrictions after first-episode syncope adequately mitigate the risk of subsequent crash.