Minimal hepatic encephalopathy is associated with motor vehicle crashes: The reality beyond the driving test
Top Cited Papers
Open Access
- 15 June 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hepatology
- Vol. 50 (4), 1175-1183
- https://doi.org/10.1002/hep.23128
Abstract
Patients with minimal hepatic encephalopathy (MHE) have impaired driving skills, but association of MHE with motor vehicle crashes is unclear. Standard psychometric tests (SPT) or inhibitory control test (ICT) can be used to diagnose MHE. The aim was to determine the association of MHE with crashes and traffic violations over the preceding year and on 1-year follow-up. Patients with cirrhosis were diagnosed with MHE by ICT (MHEICT) and SPT (MHESPT). Self and department-of-transportation (DOT)-reports were used to determine crashes and violations over the preceding year. Agreement between self and DOT-reports was analyzed. Patients then underwent 1-year follow-up for crash/violation occurrence. Crashes in those with/without MHEICT and MHESPT were compared. 167 patients with cirrhosis had DOT-reports, of which 120 also had self-reports. A significantly higher proportion of MHEICT patients with cirrhosis experienced crashes in the preceding year compared to those without MHE by self-report (17% vs 0.0%, P = 0.0004) and DOT-reports (17% vs 3%, P = 0.004, relative risk: 5.77). SPT did not differentiate between those with/without crashes. A significantly higher proportion of patients with crashes had MHEICT compared to MHESPT, both self-reported (100% vs 50%, P = 0.03) and DOT-reported (89% vs 44%, P = 0.01). There was excellent agreement between self and DOT-reports for crashes and violations (Kappa 0.90 and 0.80). 109 patients were followed prospectively. MHEICT patients had a significantly higher future crashes/violations compared to those without (22% vs 7%, P = 0.03) but MHESPT did not. MHEICT (Odds ratio: 4.51) and prior year crash/violation (Odds ratio: 2.96) were significantly associated with future crash/violation occurrence. Conclusion: Patients with cirrhosis and MHEICT have a significantly higher crash rate over the preceding year and on prospective follow-up compared to patients without MHE. ICT, but not SPT performance is significantly associated with prior and future crashes and violations. There was an excellent agreement between self- and DOT-reports. (HEPATOLOGY 2009.)Keywords
This publication has 27 references indexed in Scilit:
- Outcomes of Oregon’s Law Mandating Physician Reporting of Impaired DriversJournal of Geriatric Psychiatry and Neurology, 2009
- The Role of Reduced Fitness to Drive Due to Medical Impairments in Explaining Crashes Involving Older DriversTraffic Injury Prevention, 2008
- Navigation skill impairment: Another dimension of the driving difficulties in minimal hepatic encephalopathyHepatology, 2007
- Task-Induced Fatigue and Collisions in Adult Drivers with Attention Deficit Hyperactivity DisorderTraffic Injury Prevention, 2007
- Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathyHepatology, 2007
- Attention, Memory, and Cognitive Function in Hepatic EncephalopathyMetabolic Brain Disease, 2005
- Minimal hepatic encephalopathy impairs fitness to driveHepatology, 2004
- Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathyThe American Journal of Gastroenterology, 2001
- Subclinical hepatic encephalopathy impairs daily functioningHepatology, 1998
- Evaluation of neuropsychological function in patients with liver cirrhosis with special reference to their driving abilityMetabolic Brain Disease, 1995