Fitness-to-drive after mild traumatic brain injury: mapping the time trajectory of recovery in the acute stages post injury

Introduction: Little is known about the trajectory of recovery in fitness-to-drive after mild traumatic brain injury (mTBI). This means that health-care professionals have limited evidence on which to base recommendations to this cohort about driving.

Objective: To determine fitness-to-drive status of patients with a mTBI at 24h and two weeks post injury, and to summarise issues reported by this cohort about return to driving.

Method: Quasi-experimental case-control design. Two groups of participants were recruited: patients with a mTBI (n=60) and a control group with orthopaedic injuries (n=60). Both groups were assessed at 24h post injury on assessments of fitness-to-drive. Follow-up occurred at two weeks post injury to establish driver status.

Main measures: Mini mental state examination, occupational therapy-drive home maze test (OT-DHMT), Road Law Road Craft Test, University of Queensland-Hazard Perception Test, and demographic/interview form collected at 24h and at two weeks.

Results: At the 24h assessment, only the OT-DHMT showed a difference in scores between the two groups, with mTBI participants being significantly slower to complete the test (p=0.01). At the two week follow-up, only 26 of the 60 mTBI participants had returned to driving. Injury severity combined with scores from the 24h assessment predicted 31% of the variance in time taken to return to driving. Delayed return to driving was reported due to: "not feeling 100% right" (n=14, 23%), headaches and pain (n=12, 20%), and dizziness (n=5, 8%).

Conclusion: This research supports existing guidelines which suggest that patients with a mTBI should not to drive for 24h; however, further research is required to map factors which facilitate timely return to driving.