Predictive validity and clinical relevance of DriveSafe DriveAware as a cognitive assessment of fitness to drive in medically at-risk drivers

Objective To evaluate the predictive validity and potential clinical relevance of the DriveSafe DriveAware assessment for predicting on-road driving outcomes in medically at-risk drivers. Design Prospective cohort study. Setting Fitness-to-drive assessment pathway involving a driver licensing authority, medical review clinic, and occupational therapy driver assessors in the Australian Capital Territory, Australia. Participants A convenience sample of 138 drivers referred for occupational therapy driving assessment because of medical fitness-to-drive concerns. Methods Participants completed the DriveSafe DriveAware, comprising DriveSafe and DriveAware subtests, before an on-road driving assessment. On-road outcomes were dichotomised as pass (unrestricted licence) or fail (conditional licence, reassessment, or licence cancellation). Receiver operating characteristic analyses, Youden's Index, and classification accuracy metrics were calculated. Results DriveSafe DriveAware demonstrated strong classification performance, with 86% sensitivity, 100% specificity, 100% positive predictive value, and 93% overall accuracy. Eighty-seven percent of participants were classified as Likely to Pass or Likely to Fail , with 13% classified as Further Testing . No participants classified as Further Testing achieved an unconditional pass. DriveSafe and DriveAware subtests showed excellent discrimination (area under the curve = 0.96 and 0.95, respectively). Optimal cut-offs were broadly consistent with previously proposed thresholds. Drivers who failed the on-road assessment were older and had lower DriveSafe and DriveAware subtest scores than those who passed. Conclusion DriveSafe DriveAware showed strong predictive validity in this sample and may support triage and clinical decision-making within fitness-to-drive assessment pathways.