Prediction of on-road driving ability after traumatic brain injury and stroke

Background and purpose: The aim of the study was to examine the predictive value of widely used standardized neuropsychological tests in a clinical setting for on-road driving performance in patients with cerebral stroke or traumatic brain injury (TBI), and to provide cut-off values for neuropsychological test results under which driving should not be recommended. Methods: Data from 78 patients who had undergone comprehensive driving assessment after stroke or TBI were retrospectively included in the analysis. Patients underwent medical examination, neuropsychological testing and on-road assessment. Medical data, demographic variables and neuropsychological performance were used as predictors in a stepwise logistic regression analysis with pass/fail after the on-road test as the dependent variable. Receiver operating characteristic curve analysis was employed to select cut-off values for the tests that were significant predictors for on-road performance. Results: Forty-three patients passed and 35 failed the on-road driving task. Logistic regression analysis revealed three significant neuropsychological tests (CalCap simple reaction time, Trail Making Test A, Grooved Pegboard) as predictors for on-road performance explaining 46% of the variance with an overall classification accuracy of 82.1%. Receiver operating characteristic curve analysis showed the following cutoff values: CalCap, 395 ms; Trail Making Test A, 46 s; Grooved Pegboard, 97.5 s. Conclusion: The results suggest that driving ability after brain damage and cerebral disease with no severe neurological deficits can be measured with a few distinctive neuropsychological tests together with medical examination and on-road assessment. Cut-off scores are a useful supplement to normative data/scaled scores.