Factors Impairing Driving
active metabolites
Active Metabolites like Tramadol’s major active metabolite O-desmethyltramadol
(ODT) possesses greater affinity for the mu-opioid receptor and has double the affinity for the mu-opioid receptor and has double the analgesic potency of the parent drug and can adversely impact driving skills.
For the heroin metabolite morphine-6-glucuronide (M6G), the median blood concentration was 0.09 micromol/l in the “not impaired” group and 0.14 micromol/l in the “impaired” group (P=0.030)
A significant correlation between concentration quartiles and number of cases determined as “impaired” was found for M6G (P=0.018) and for the sum M=M6G (P=0.013).
ADHD
Attention-deficit/hyperactivity disorder (ADHD), (aOR = 2.18 CI: [1.22–3.88]).
The combined effect of ADHD and external distractions is powerfully related with responsibility for the crash (aOR=5.79 Cl; [2.06-16.32])
Adults with ADHD are a group of people that are at higher risk of being responsible for a road traffic crash when exposed to external distractions.
AGING
The 85 year old and older age group reported more motor vehicle crashes (OR = 2.79, 95% CI 1.88-4.12) compared to the middle-aged (55-64 years).
Significant age related decrements being markedly visible after 40 years of age but most pronounced in the 70-79 and 80-89 year age groups.
There was a 13 fold increase in crash involvement reported among drivers who were 80 and over.
However marked increase in crash involvement did not start until 75 years of age.
The highest death rates per mile driven, a 13-fold increase, was observed among drivers aged 80 or older, who also had the highest crash death rates.
A review of 23 studies using random-effects meta-regression analyses found that majority who sustained minor trauma due to Motor-Vehicle Collision (MVC) were older male adults who were aged between 60 and 74 years.
Road traffic injuries compromised 23.6% of total injuries among elderly.
The most frequent injuries were about car accidents (51.4%).
Pedestrian injuries composed 48.1% of the RTIs.
Head and neck (32.1%) were most injured body parts.
There was a significant difference between elderly and non-elderly people in terms of Road Traffic Injuries associated mortality (Odd=2.57 [1.2-5.4 CI 95%]).
The overall pooled mortality rate was 14% (95% Confidence Interval, CI: 11%, 16%), with higher mortality rates in studies conducted in North America (15%, 95% CI: 12%, 18%) and older adults admitted to trauma centers (17%, 95% CI: 14%, 21%).
Secondary analysis showed that the very elderly adults (aged >75 years) had higher odds of mortality death (Odds Ratio, OR: 2.05, 95% CI: 1.25, 3.38.
The elderly were nearly 7 seven times more likely to die as a pedestrian compared to other age groups.
In a multivariable model, elderly patients aged >=75 years (adjusted OR [AOR] 4.34; 95% CI: 2.29-8.23), nighttime (AOR 2.75; 95% CI: 1.65-4.70), and type of injured person compared with bicyclists such as pedestrian (AOR 9.58; 95% CI: 5.07-17.99), motorcyclist (AOR 2.75; 95% CI: 1.21-6.24), and car occupant (AOR 2.98; 95% CI: 1.39-6.40) were significantly associated with prehospital death due to traffic accidents.
Also, the AOR for automobile versus non-automobile as the collision opponent was 4.76 (95% CI: 2.30-9.88).
Compared to younger participants ( 18-40 year old), older drivers ( 60 and over) experienced significantly slower reaction times (510.0 ± 208.8 vs. 372.4 ± 96.1 msec, p = 0.0004), had more collisions (0.18 ± 0.39 vs. none, p = 0.0044), drove slower (44.6 ± 6.6 vs. 54.9 ± 11.7 mph, p < 0.0001), deviated less in speed (12.6 ± 4.3 vs. 16.8 ± 6.3, p = 0.0011), and were less able to maintain a constant distance behind a pace car (0.42 ± 0.23 vs. 0.59 ± 0.24; p = 0.0025).
Alcohol
In Sweden between 1987 and 2015, a 1 L increase in per capita consumption was associated with a 17% increase in drink driving.
Using day-level data on municipalities, alcohol bans caused substantial reductions in road crashes (19%), traffic injuries (43%), and traffic-related hospitalizations (17%).
Based on self- reporting, alcohol increases the Odds Ratio (ORs) for having an accident alcohol was 3.5 (95% CI: 1.73-7.06).
In Finland from 2000-2016 there were 3,447 fatally injured drivers from motor vehicle accidents of which 25% (n = 869) were intoxicated (BAC≥0.05%).
A 2017 study in France found that the proportion of persons driving under the influence of alcohol is estimated at 2.1% (95% CI: 1.4-2.8).
Drivers who are under the influence of alcohol are 17.8 times (12.1-26.1) more likely to be responsible for a fatal accident, and the proportion of fatal accidents which would be prevented if no drivers ever exceeded the legal limit for alcohol is assessed at 27.7% (26.0%-29.4%).
ALL Drugs
The crude OR of having a crash for all drugs was 3.83 (95%CI: 2.28-6.43).
arthritis /rheumatism
Increased odds of subsequent motor vehicle injuries were found for arthritis/rheumatism (OR: 1.659, 95% CI: 1.163, 2.365)
asthma
Increased odds of subsequent motor vehicle injuries were found for asthma (odds ratio [OR]: 1.864, 95% confidence interval [CI]: 1.281, 2.713)
alcohol and cannabis combined
Compared to drivers testing negative for alcohol and marijuana, the adjusted odds ratios of fatal crash involvement were 16.33 [95% confidence interval (CI): 14.23, 18.75] for those testing positive for alcohol and negative for marijuana, 1.54 (95% CI: 1.16, 2.03) for those testing positive for marijuana and negative for alcohol, and 25.09 (95% CI: 17.97, 35.03) for those testing positive for both alcohol and marijuana.
In a case-crossover self-report study a significant odds ratio increase was found for driving-related injury after combined exposure to cannabis and alcohol compared to cannabis alone (OR of 10.9 and 5.8 respectively).
Alzheimers / Frontotemporal lobar degeneration
Frontotemporal lobar degeneration (FTLD) patients reported difficulty in judging inter-vehicle distances, ignoring road signs and traffic signals, and distraction were reported in 50% (14/28), 61% (17/28), and 50% (14/28) of patients, respectively, and 75% (21/28) patients had caused a traffic accident after dementia onset.
The risk of causing an accident was higher in the FTLD group than in the Alzheimer's disease (AD group (odds ratio = 10.4, 95% confidence interval = 3.7-29.1). Furthermore, the mean duration between dementia onset and a traffic accident was 1.35 years in the FTLD group compared with 3.0 years in the AD group (P < 0.01)
antidepressants
The risk of MVA was increased in current users of selective serotonin reuptake inhibitors (SSRIs; OR 1.13; 95% CI 1.04-1.22), but not in current users of tricyclic antidepressants (TCAs; OR 1.04; 95% CI 0.96-1.14).
A Korean study of 1,250 antidepressant-using drivers found that they had an increased risk of a road accident fatality (adjusted OR 1.30; 95% CI 1.03-1.63).
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) showed significant risks, but tricyclic antidepressants did not.
Antipsychotics
The Odds ratio (OR) for motor vehicle crashes associated with the use of atypical antipsychotics is significant at 2.20 (P < .01).
anxiety
It was found that anxiety could increase the odds ratio (OR) of road accidents by 2.7-folds. (P=0.004).
back problems
Increased odds of subsequent motor vehicle injuries were found for back problems (OR: 2.169, 95% CI: 1.624, 2.895),
birthdays
A total of 1028 patients attended within the 7 days starting from their birthday (expected number 49, 211/52 = 946). This was found to be statistically significant (P = 0.0071).
Road traffic accidents were more frequent on both the birthday week and the week after birthday.
Medical emergencies, injury in a public place, 19-35 years age group and male patients showed similarly significant association but for the week after birthday only.
Cannabis
US data from the 2013 National Roadside survey established that overall, 8.9% and 9.4% of the participants tested positive for THC in oral fluid and whole blood samples, respectively.
Using blood test as the reference standard, oral fluid test for THC positivity showed a sensitivity of 79.4% (95% CI: 75.2%, 83.1%) and a specificity of 98.3% (95% CI: 97.9%, 98.7%).
Multivariable regression established that the frequency of marijuana use was significantly associated with a greater risk of driving under the influence of marijuana among racially diverse US young adults.
Peer marijuana use was associated with greater risk of riding under the influence of marijuana that also increased crash risk.
Driving while cannabis-impaired approximately doubles car crash risk and that around one in 10 regular cannabis users develop dependence.
The crude OR of having a crash for cannabis is 2.37 (95% CI: 1.03-5.42)
When THC-COOH urine analysis levels exceeded 15 ng/ml, there was a high association between the presence of THC-COOH in urine and the occurrence of traffic accidents. Odds Ratio=10.88 (P<0.0001)
There was a 5 fold increase in the prevalence of THC and alcohol involved in fatal crashes from below 2% in 1991 to just above 10% in 2008.
A US prospective cross-sectional study assessed 31 chronic marijuana users and 41 nonusers.
They found that marijuana users were more likely to fail the Standardized Field Sobriety Test (P=.005) and the Walk and Turn (P=.012) and Horizontal Gaze Nystagmus (P=.001) components.
Marijuana users had slower Simple Visual Reaction Time test (P=.031), less Standard Deviation of Speed (SDS), P=.039), and lower modulus(P=.003).
Participants with Tetrahydrocannabinol (THC) >2 ng/mL (P=.017) and TCH >5 ng/mL (P=.008) had lower SDS.
Participants with THC >2 ng/mL (P=.021) and THC >5 ng/mL (P=.044) had decreased modulus.
A French study in November 2017 found that 3.4% (CI 2.9%-3.9%) of drivers were under the influence of cannabis while driving their vehicle.
Drivers who are under the influence of cannabis increase their risk of being responsible for causing a fatal accident by 1.65 times (CI 1.16-2.34), and the percentage of fatal accidents which would be prevented if no drivers ever drove under the influence of cannabis is estimated at 4.2% (CI 3.7%-4.8%).
Cell phone texting
Use of a cell phone while driving increases the risk of crashing fourfold.
Texting a message increases reaction time by 94.94%, conversation by 13.34% and listening to music while driving by 1.58%
cetirizine
The baseline Reaction Time Index [RTI (95.46±41.74, 85.11±39.05)] and Critical Flicker Fusion Frequency per second=CFF/sec low and high (40.07±9.970, 40.76±9.309 and 40.42±9.035, 40.48±9.863) respectively, in Cetirizine group and Mobile user group were comparable.
The RTI increased significantly (116.4±51.46, 102.8±49.26) in both the groups after intervention
childhoood traffic accidents
Not restraining increased the risk of serious Road Traffic Accidents by 8.4 times in children 0-16 years of age.
Among male participants risky driving behavior was associated with having a degree (ORa=2, 95% CI [1.1-3.8]), sport practices (ORa=3.7, 95% CI [1.9-7.05]), involvement in a fight in the last twelve months (ORa=2.2, 95% CI [1.4-3.4]) and precocity of cannabis use (ORa=1.8, 95% CI [1.2-2.8]).
Youth living in couple and those with children presented with higher risk-taking scores.
Among female participants, young age at cannabis initiation (ORa=3.1, 95% CI [1.5-6.4]) and at sexual debut (ORa=2.4, 95% CI [1.1-5.1]) were associated with driving risk-taking.
Finally, younger age at first alcohol intoxication was associated with risky behavior on the road in both sexes.
Traffic accidents in children was significantly associate with the width of the alleys or (<5 m: OR = 8.4, 95% CI: 3.3-21.5; 5-8 m: OR = 4.7, 95% CI: 1.8-12.2), distance from home to school (<100 m: OR = 1.7, 95% CI: 1.0-2.8), existence of parking lot (OR = 1.5, 95% CI: 1.0-2.3), traffic congestion (OR = 4.1, 95% CI: 2.6-6.4), traffic speed (OR = 2.1, 95% CI: 1.3-3.2) and existence of pedestrian bridges (OR = 4.2, 95% CI: 2.6-6.8).
Adjusted analysis shows that Guatemalan students had a 4.8 times higher accident rate (CI 95% 3.1-7.4) compared to Spanish students.
This was primarily due to higher mobile usage (74.4 % versus 24.3 %), distraction (47.1 % versus 18.8 %) or not using a seat-belt (23.9% vs 5.9).
10.6% of boys and 6.5% of girls reported a car accident in the previous 12 months period.
12th grade alcohol mixed with energy drinks users were significantly more likely to be in a motor vehicle accident (p <.001) and receive a ticket for a traffic violation (p <.05).
Additionally, 12th grade AmED users were significantly less likely to wear a seatbelt as a driver or passenger (p <.001).
colours
For females the results showed that both red and green had significantly less choice visual choice reaction (P values <0.0001 and 0.0002) when compared with yellow.
cigarette smoking
During a 20 years of follow-up of the Ibaraki Prefectural Health Study in Japan, the average person-year of follow-up were 16.8 and 18.2 in men and women, respectively.
Among men, after adjusting for age and alcohol intake, compared with non-smokers, HRs for traffic accident death among current smokers of <20 cigarettes/day and ≥20 cigarettes/day were 1.32 (95% confidence interval (CI), 0.79-2.20) and 1.54 (95% CI, 0.99-2.39), respectively.
In contrast, among women, there was no relationship between smoking status and traffic accident deaths.
commencing sedating drugs
New sedative users were associated with an increased risk of crash compared to nonusers.
Temazepam hazard ratio (HR) = 1.27 (95% confidence interval [CI] = 0.85, 1.91), trazodone HR = 1.91 (95% CI = 1.62, 2.25), and zolpidem HR = 2.20 (95% CI = 1.64, 2.95).
The risk estimates are equivalent to blood alcohol concentration levels between 0.06% and 0.11%.
Drivers consuming Tramadol (adjusted OR 11.41; 95 % CI 1.27, 102.15) were at a significantly increased risk of motor vehicle collision.
Statistically significant associations between drug use and road traffic crashes involvement were found for benzodiazepines and z-hypnotics in 25 out of 28 studies, for cannabis in 23 out of 36 studies, for opioids in 17 out of 25 studies, for antidepressants in 9 out of 13 studies, for amphetamines in 8 out of 10 studies and for cocaine in 5 out of 9 studies.
Using multivariate logistic regression analysis, mental disorders were significantly associated with injuries in the past three months (OR=1.6, 95% CI: 1.36-1.87), recurrent injuries (OR=1.7, 95% CI: 1.21-2.41) and road/traffic accidents (OR=2.4, 95% CI: 1.28-4.49).
Risk of motor vehicle accidents ( MVA)s was higher in current users of long-acting benzodiazepines [OR 1.23; 95% confidence interval (CI) 1.16-1.29] than in current users who consume short-acting benzodiazepines (OR 1.05; 95% CI 1.02-1.08).
The highest ORs of MVA were found in long-acting benzodiazepines users concurrently using SSRIs (OR 1.37; 95% CI 1.07-1.77, P value for interaction = 0.964) or TCAs (OR 1.54; 95% CI 1.21-1.95, P value for interaction = 0.077).
There have been 27 studies that have established that Buprenorphine, Codeine, Dihydrocodeine, Methadone, Tramadol, Levocitirizine, Diazepam, Flunitrazepam, Flurazepam, Lorazepam, Temazepam, Triazolam, Carisoprodol, Zolpidem, and Zopiclone were associated with an increased risk of a motor vehicle accident.
cyclists
The effect of running lights was studied where lights were mounted to 1,845 bicycles and 2,000 others comprised a control group.
Bicycle accidents were recorded every 2 months in a year through self-reporting on the Internet.
Participants reported a total of 255 accidents i.e. 7 accidents per 100 cyclists.
Results showed that the incidence rate for multiparty bicycle accidents with personal injury was 47% lower for cyclists with permanent running light that was statistically significant.(P<0.05)
The effect of a yellow bicycle jacket was examined through a trial with 6,800 volunteer cyclists.
Half of the group received a bicycle jacket and the other half comprised a control group.
Participants reported a total of 694 accidents i.e. 10 accidents per 100 cyclists with multiparty accidents with personal injury being 38% than the control group.(P<0.05).
CYCLISTS – ELECTRONIC BIKES
In Switzerland a survey was conducted among 3658 e-cyclists in 2016. The crash risk and injury severity were examined using logistic regression models. 638 (17%) e-cyclists had experienced a single-vehicle accident in road traffic since the start of their e-bike use. Risk factors were male sex, high riding exposure, and using the e-bike mainly to get to work or school.
Skidding, falling while crossing a threshold, getting into or skidding on a tram/railway track and evasive actions were the most significant accident mechanisms.
Most frequent crash causes were a slippery road surface, riding too fast for the situation and inability to keep the balance.
Women, elderly people, riders of e-bikes with a pedal support up to 45?km/h and e-cyclists less fit in comparison to people of matching had an increased risk of injury.
diurnal variation
The majority of patients (n=6962) were injured during daylight hours and bright sunlight was the most common weather condition at the time and place of the crash.
The risk of a life-threatening crash was 16% higher during bright sunlight than normal weather (95% confidence interval: 9-24, P<0.001).
The increased risk was accentuated in the early afternoon, disappeared at night, extended to patients with different characteristics, involved crashes with diverse features, not apparent with cloudy weather, and contributed to about 5000 additional patient-days in hospital
30% of night shift and 16.7% of day shift nurses reported traffic accidents in the past year.
Results showed that, scores based on viewing times in visual orientation test (p=0.005), and median reaction time score in choice reaction time and reactive stress tolerance test (p=0.045), had a significant association with a 12-hour night shift with a 3-hour nap.
depression
It was found that depression could increase the odds ratio (OR) of road accidents by 2.4-(P=0.04)
distracted driving
Factors associated with responsibility were distraction induced by an external event (adjusted OR (aOR) = 1.47; 95% confidence interval (CI) [1.06–2.05]), distraction induced by an internal thought (aOR = 2.38; CI: [1.50–3.77])
driver demographics
612 car drivers, 37.3% (228) reported being involved in a road traffic accident with damage or injury in the past 3 years.
Majority in this group were male, older than 65, with no children, not employed and living in an urban area. In the multivariate model, several factors were identified: being widowed (vs. single) (OR = 3.478, CI 95%: 1.159-10.434); living in a suburban area (vs. a rural area) (OR = 5.023, CI 95%: 2.260-11.166); having been checked for alcohol once in the last 3 years (vs. not checked) (OR = 3.124, CI 95%: 2.040-4,783); and seldom drinking an energetic beverage such as coffee when tired (vs. always do it) (OR = 6.822, CI 95%: 2.619-17.769) all suffered a higher risk of being involved in a car accident.
A total of 21,679 road traffic crashes ( RTC) incidents resulting in 24,147 victims were recorded from 2010 to 2012 in a redevelopment area of Shanghai.
RTC tended to occur among male (81.8%) aged 20-49 years old (84.9%) riding buses (60.1%) or electric bikes (16.1%) in working time (15%).
The network spatial analysis identified the hotspots of RTC at the street level in the Songjiang network urban area, and more RTCs occurred at road intersections than on road segments.
driver experience
Young people (15-29 years) were twice as likely to be hospitalized due to severe injuries.
Young motorcyclists had a 2.5 times greater chance of suffering accidents (p = <0.001), however the use of other vehicles such as buses, cars, bicycles, and trucks represented a protective factor for this group (p = <0.05).
Multiple logistic regression revealed main predictors for the occurrence of accidents were being single, having over 8 years of education, having had a driver's license for less than 3 years, driving at night and roads with low luminosity.
We identified the following traffic accident predictors: having few years of experience as professional drivers (OR = 1.86; CI 95% = 1.05-3.38; p = 0.036); receiving some traffic tickets (OR = 1.91; CI 95% = 1.04-3.66; p = 0.043) and working more than 12 hours daily (OR = 1.84; CI 95% = 1.04-3.24; p = 0.034).
The number of years as a driver (PR 1.03, IC 1.00-1.05, p = 0.02) were associated with an accident or near accident.
DRIVER FATALITY IN VEHICLE- FIXED OBJECT ACCIDENTS
Results s in vehicle-fixed object accidents on expressways in Changsha-Zhuzhou-Xiangtan district of Hunan province in China showed that the turning direction in avoiding fixed objects increased the possibility that drivers would die.
Around 64% of drivers died in the accident were found being ejected out of the car, of which 50% were not using a seatbelt before the fatal accidents.
Drivers are likely to die when they encounter bad weather on the expressway.
Drivers with less than 10 years of driving experience are more likely to die in these accidents.
Fatigue or distracted driving is also an important factor in fatality of drivers.
drug interactions
Drugs with similar properties such as alcohol and cannabis, alcohol and benzodiazepines or ecstasy and amphetamines when taken together can increase the effects of each drug to impair driving.
APPENDIX VIII. Table 3B Significant Odds Ratios for Drug Interactions
| DRUG_DRUG | DRUG 1 | DRUG 2 | OR | L_OR | U_OR | P-VALUE | A | B | C | D |
| H4B W3B | ANTICONVULSANTS | ANTIFUNGAL AGENTS | 21.00 | 2.58 | 170.69 | 0.00 | 7 | 4502 | 1 | 13526 |
| H7C W1Q | SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) |
QUINOLONES | 21.00 | 2.58 | 170.69 | 0.00 | 7 | 4502 | 1 | 13526 |
| H6H H7T | SKELETAL MUSCLE RELAXANTS | ANTIPSYCHOTICS,ATYPICAL,DOP AMINE,& SEROTONIN ANTAG |
18.00 | 2.17 | 149.52 | 0.01 | 6 | 4503 | 1 | 13526 |
| C4K W2A | HYPOGLYCEMICS, INSULIN RELEASE STIMULANT TYPE |
ABSORBABLE SULFONAMIDES | 15.00 | 1.75 | 128.40 | 0.01 | 5 | 4504 | 1 | 13526 |
| H2S H7B | SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) | ALPHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTS |
15.00 | 1.75 | 128.40 | 0.01 | 5 | 4504 | 1 | 13526 |
| H4B J2A | ANTICONVULSANTS | BELLADONNA ALKALOIDS | 12.00 | 1.34 | 107.37 | 0.03 | 4 | 4505 | 1 | 13526 |
| H2U H7T | TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB |
ANTIPSYCHOTICS,ATYPICAL,DOP AMINE,& SEROTONIN ANTAG |
10.50 | 2.18 | 50.55 | 0.00 | 7 | 4502 | 2 | 13525 |
| H2F W1K | ANTI-ANXIETY DRUGS | LINCOSAMIDES | 7.50 | 1.46 | 38.66 | 0.02 | 5 | 4504 | 2 | 13525 |
| H2S H7C | SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) |
7.50 | 1.46 | 38.66 | 0.02 | 5 | 4504 | 2 | 13525 |
| H2D H4B | BARBITURATES | ANTICONVULSANTS | 6.00 | 1.50 | 23.99 | 0.01 | 6 | 4503 | 3 | 13524 |
| C4G H7C | INSULINS | SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) |
6.00 | 1.10 | 32.76 | 0.04 | 4 | 4505 | 2 | 13525 |
| C4K H2U | HYPOGLYCEMICS, INSULIN RELEASE STIMULANT TYPE |
TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB |
4.50 | 2.02 | 10.02 | 0.00 | 15 | 4494 | 10 | 13517 |
| H7T Z2A | ANTIPSYCHOTICS,ATYPICAL,DOP AMINE,& SEROTONIN ANTAG |
ANTIHISTAMINES | 4.20 | 1.33 | 13.23 | 0.01 | 7 | 4502 | 5 | 13522 |
| M9L S2B | ORAL ANTICOAGULANTS,COUMARIN TYPE |
NSAIDS, CYCLOOXYGENASE INHIBITOR - TYPE | 4.15 | 2.04 | 8.48 | 0.00 | 18 | 4491 | 13 | 13514 |
| H6H W1D | SKELETAL MUSCLE RELAXANTS | MACROLIDES | 4.07 | 2.04 | 8.12 | 0.00 | 19 | 4490 | 14 | 13513 |
| H2S W1Q | SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
QUINOLONES | 4.00 | 2.17 | 7.37 | 0.00 | 24 | 4485 | 18 | 13509 |
| H2E H4B | SEDATIVE-HYPNOTICS,NON BARBITURATE |
ANTICONVULSANTS | 3.92 | 1.91 | 8.08 | 0.00 | 17 | 4492 | 13 | 13514 |
| H3A H7T | ANALGESICS,NARCOTICS | ANTIPSYCHOTICS,ATYPICAL,DOP AMINE,& SEROTONIN ANTAG |
3.75 | 1.48 | 9.50 | 0.01 | 10 | 4499 | 8 | 13519 |
| B3J W5A | EXPECTORANTS | ANTIVIRALS, GENERAL | 3.75 | 1.01 | 13.97 | 0.05 | 5 | 4504 | 4 | 13523 |
| H7T J7C | ANTIPSYCHOTICS,ATYPICAL,DOP AMINE,& SEROTONIN ANTAG |
BETA-ADRENERGIC BLOCKING AGENTS |
3.75 | 1.01 | 13.97 | 0.05 | 5 | 4504 | 4 | 13523 |
| H4B H7C | ANTICONVULSANTS | SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) |
3.67 | 1.52 | 8.85 | 0.00 | 11 | 4498 | 9 | 13518 |
| H2S H3A | SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
ANALGESICS,NARCOTICS | 3.64 | 2.72 | 4.85 | 0.00 | 104 | 4405 | 88 | 13439 |
| J5D Z2F | BETA-ADRENERGIC AGENTS | MAST CELL STABILIZERS | 3.60 | 1.10 | 11.80 | 0.03 | 6 | 4503 | 5 | 13522 |
| M4E W1K | LIPOTROPICS | LINCOSAMIDES | 3.60 | 1.10 | 11.80 | 0.03 | 6 | 4503 | 5 | 13522 |
| M9L W1W | ORAL ANTICOAGULANTS,COUMARIN TYPE |
CEPHALOSPORINS - 1ST GENERATION | 3.60 | 1.10 | 11.80 | 0.03 | 6 | 4503 | 5 | 13522 |
| H2F H7C | ANTI-ANXIETY DRUGS | SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) |
3.55 | 1.59 | 7.91 | 0.00 | 13 | 4496 | 11 | 13516 |
| H2F W3B | ANTI-ANXIETY DRUGS | ANTIFUNGAL AGENTS | 3.43 | 1.24 | 9.45 | 0.02 | 8 | 4501 | 7 | 13520 |
| H2F H2U | ANTI-ANXIETY DRUGS | TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB |
3.40 | 2.08 | 5.56 | 0.00 | 34 | 4475 | 30 | 13497 |
| H2S H7T | SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
ANTIPSYCHOTICS,ATYPICAL,DOP AMINE,& SEROTONIN ANTAG |
3.40 | 1.70 | 6.81 | 0.00 | 17 | 4492 | 15 | 13512 |
| A1A A2A | DIGITALIS GLYCOSIDES | ANTIARRHYTHMICS | 3.38 | 1.30 | 8.75 | 0.01 | 9 | 4500 | 8 | 13519 |
| C4N H2S | HYPOGLYCEMICS, INSULIN RESPONSE ENHANCER (N-S) |
SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
3.30 | 1.40 | 7.77 | 0.01 | 11 | 4498 | 10 | 13517 |
| H6H W1Q | SKELETAL MUSCLE RELAXANTS | QUINOLONES | 3.27 | 1.44 | 7.42 | 0.00 | 12 | 4497 | 11 | 13516 |
| H2U W1D | TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB |
MACROLIDES | 3.00 | 1.39 | 6.47 | 0.01 | 13 | 4496 | 13 | 13514 |
| M9L M9P | ORAL ANTICOAGULANTS,COUMARIN TYPE |
PLATELET AGGREGATION INHIBITORS | 3.00 | 1.05 | 8.55 | 0.04 | 7 | 4502 | 7 | 13520 |
| B3J H2S | EXPECTORANTS | SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
2.96 | 1.70 | 5.17 | 0.00 | 25 | 4484 | 26 | 13501 |
| H4B M9L | ANTICONVULSANTS | ORAL ANTICOAGULANTS,COUMARIN TYPE |
2.93 | 1.39 | 6.19 | 0.00 | 14 | 4495 | 15 | 13512 |
| H4B W1D | ANTICONVULSANTS | MACROLIDES | 2.80 | 1.35 | 5.80 | 0.01 | 14 | 4495 | 15 | 13512 |
| H2E H3A | SEDATIVE-HYPNOTICS,NON BARBITURATE |
ANALGESICS,NARCOTICS | 2.79 | 1.85 | 4.20 | 0.00 | 45 | 4464 | 49 | 13478 |
| H2F H2S | ANTI-ANXIETY DRUGS | SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
2.71 | 2.02 | 3.64 | 0.00 | 85 | 4424 | 94 | 13433 |
| C4L H2S | HYPOGLYCEMICS, BIGUANIDE TYPE (NON-SULFONYLUREAS) |
SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
2.68 | 1.40 | 5.16 | 0.00 | 17 | 4492 | 19 | 13508 |
| A1A R1F | DIGITALIS GLYCOSIDES | THIAZIDE AND RELATED DIURETICS |
2.67 | 1.03 | 6.91 | 0.04 | 8 | 4501 | 9 | 13518 |
| A9A H7E | CALCIUM CHANNEL BLOCKING AGENTS | SEROTONIN-2 ANTAGONIST/REUPTAKE INHIBITORS (SARIS) |
2.63 | 1.28 | 5.38 | 0.01 | 14 | 4495 | 16 | 13511 |
| H2S M9L | SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) | ORAL ANTICOAGULANTS,COUMARIN TYPE |
2.57 | 1.19 | 5.56 | 0.02 | 12 | 4497 | 14 | 13513 |
| H2U W1Q | TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB |
QUINOLONES | 2.45 | 1.02 | 5.92 | 0.05 | 9 | 4500 | 11 | 13516 |
| C4K H2S | HYPOGLYCEMICS, INSULIN RELEASE STIMULANT TYPE |
SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
2.44 | 1.39 | 4.29 | 0.00 | 22 | 4487 | 27 | 13500 |
| H2F W1D | ANTI-ANXIETY DRUGS | MACROLIDES | 2.42 | 1.36 | 4.31 | 0.00 | 21 | 4488 | 26 | 13501 |
| H2F J5D | ANTI-ANXIETY DRUGS | BETA-ADRENERGIC AGENTS | 2.36 | 1.41 | 3.95 | 0.00 | 26 | 4483 | 33 | 13494 |
| H2S H3F | SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
ANTIMIGRAINE PREPARATIONS | 2.35 | 1.27 | 4.35 | 0.01 | 18 | 4491 | 23 | 13504 |
| H2U H3A | TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB |
ANALGESICS,NARCOTICS | 2.34 | 1.62 | 3.39 | 0.00 | 50 | 4459 | 64 | 13463 |
| P5A W1D | GLUCOCORTICOIDS | MACROLIDES | 2.31 | 1.51 | 3.55 | 0.00 | 37 | 4472 | 48 | 13479 |
| C4L H2U | HYPOGLYCEMICS, BIGUANIDE TYPE (NON-SULFONYLUREAS) |
TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB |
2.29 | 1.11 | 4.72 | 0.02 | 13 | 4496 | 17 | 13510 |
| C4G D4K | INSULINS | GASTRIC ACID SECRETION REDUCERS |
2.21 | 1.32 | 3.70 | 0.00 | 25 | 4484 | 34 | 13493 |
| H2F W1Q | ANTI-ANXIETY DRUGS | QUINOLONES | 2.20 | 1.27 | 3.81 | 0.00 | 22 | 4487 | 30 | 13497 |
| C7A D4K | HYPERURICEMIA TX - PURINE INHIBITORS |
GASTRIC ACID SECRETION REDUCERS |
2.12 | 1.01 | 4.46 | 0.05 | 12 | 4497 | 17 | 13510 |
| C4K W1D | HYPOGLYCEMICS, INSULIN RELEASE STIMULANT TYPE |
MACROLIDES | 2.05 | 1.06 | 3.94 | 0.03 | 15 | 4494 | 22 | 13505 |
| A9A D4K | CALCIUM CHANNEL BLOCKING AGENTS |
GASTRIC ACID SECRETION REDUCERS |
1.77 | 1.35 | 2.33 | 0.00 | 85 | 4424 | 145 | 13382 |
| C4K D4K | HYPOGLYCEMICS, INSULIN RELEASE STIMULANT TYPE |
GASTRIC ACID SECRETION REDUCERS |
1.75 | 1.13 | 2.73 | 0.01 | 31 | 4478 | 53 | 13474 |
| H2S M4E | SEROTONIN SPECIFIC REUPTAKE INHIBITOR (SSRIS) |
LIPOTROPICS | 1.75 | 1.33 | 2.32 | 0.00 | 79 | 4430 | 136 | 13391 |
| B3J Z2A | EXPECTORANTS | ANTIHISTAMINES | 1.74 | 1.06 | 2.86 | 0.03 | 25 | 4484 | 43 | 13484 |
| M4E W1Q | LIPOTROPICS | QUINOLONES | 1.55 | 1.02 | 2.34 | 0.04 | 34 | 4475 | 66 | 13461 |
| C4K C4L | HYPOGLYCEMICS, INSULIN RELEASE STIMULANT TYPE |
HYPOGLYCEMICS, BIGUANIDE TYPE (NON-SULFONYLUREAS) |
1.44 | 1.13 | 1.85 | 0.00 | 94 | 4415 | 196 | 13331 |
| A4D A9A | HYPOTENSIVES, ACE INHIBITORS | CALCIUM CHANNEL BLOCKING AGENTS |
1.31 | 1.03 | 1.66 | 0.03 | 100 | 4409 | 230 | 13297 |
Leroy A, Morse MM.APPENDIX VIII. Table 3B Significant Odds Ratios for Drug Interactions. US Department of Transportation/National Highway Traffic Safety Administration. Exploratory study of the relationship between multiple medications and vehicle crashes: analysis of databases. Washington, DC: U.S.DOT/NHTSA; 2008: Publication DTNH22-02-C-05075. P210 May, 2008.
https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/810858.pdf
EPILEPSY
In Saudi Arabia, 54 % of patients with Epilepsy (PWEs) were deemed to be unfit to drive.
Of 118 participants, 17.7% did not drive and 97 (82.3%) drove.
Of the 21 patients who did not drive, 14 (11.8% of the total sample) never drove and 7 (5.9% of the total sample) ceased driving due to their epilepsy.
Of 104 patients who drove, 45 (43.2% of the total sample) had a history of seizures while driving.
This resulted in 28 patients (26.9% of the total sample) being involved in motor vehicle accidents and 17(16.3% of the total sample) patients being admitted to the emergency room.
658 adult seizure patients visited the Department of Neurology, Saiseikai Utsunomiya Hospital, Utsunomiya, emergency department between January 2011 and December 2016.
Data for analysis focused on daily activities immediately before seizure and 2.9% of patients sustained a seizure while driving.
Patients were dichotomized on the basis of whether he or she had been diagnosed with epileptic seizure (ES).
Seven of the 307 patients with ES vs. 12 of the 351 patients without ES sustained seizure while driving.
Frequencies did not differ significantly between the 2 groups (2.3% vs. 3.4%, p=0.49).
Structural lesions on brain imaging studies were found in 6 of the 12 patients without ES (50%).
Sixteen of the 19 patients (84%) caused automobile accidents after seizure.
Among the 7 patients with ES, antiepileptic drugs had not been prescribed in 3 (43%).
EYE diseases
Central Field Loss participants reacted more slowly to pedestrians that appeared in the area of visual field loss than in non-scotomatous areas (4.3 vs. 2.4 seconds) and had more late and missed responses than controls (29% vs. 3%)
Dry eye disease was correlated with unsafe driving habits and performance, which may increase the risk of dangerous driving (P<0.01).
For patients with dry eye disease, the rate of accidents and near-accidents was 10.33%, and the rate of missed targets totalled 32.17%
Advanced glaucoma patients were involved in a significantly higher number of collisions in a driving simulator than the age-matched and driving exposure time-matched normal subjects (119 vs 40, respectively, p<0.0001), particularly in four specific driving simulator scenarios.
With these four scenarios, binocular integrated visual field sensitivity was significantly lower in the collision-involved patients than in the collision-uninvolved patients in subfields on or near the track of the simulated hazard (p<0.05).
The subfields with the largest area under the receiver operating characteristic (AUROC) curve had values ranging from 0.72 to 0.91 and were located in the paracentral visual field just below the horizontal.
Among male subjects with primary open-angle glaucoma, the prevalence of motor vehicle collisions was significantly higher in the no-restriction group than in the self-restriction group (no-restriction group, 33/107 = 30.8%; self-restriction group, 9/66 = 13.6%, p = 0.01).
The crash rate was also significantly higher in the no-restriction group (no-restriction group, 1.4 ± 0.8; self-restriction group, 0.4 ± 0.3, average ± SE, p = 0.01).
No restriction was significantly associated with motor vehicle collisions (multivariable-adjusted odds ratios, 2.43 [95% confidence interval, 1.03 to 5.73]).
The number of driving self-restrictions was also associated with motor vehicle collisions (multivariable-adjusted odds ratios, 0.41 [95% confidence interval, 0.18 to 0.99], per one increment of self-restriction).
FOOD
The results of the logistic regression analysis showed that yoghurt consumption was an independent risk factor for traffic accidents (odds ratio, 0.37; 95% confidence interval, 0.16-0.85; P=0.0197).
Results of the decision-tree analysis showed that yoghurt consumption was the initial divergence variable.
Patients who consumed yoghurt regularly, the incidence of traffic accidents was 6.6%, while that in patients who did not consume yoghurt was 16.0%.
Diets to reduce cholesterol may result in driver impairment.
heart disease
Multivariate Cox model has shown a significant association between involvement in motor vehicle crashes and mild-to-moderate valvular heart disease (p = 0.0002, chi 2 = 13.89),
heroin
Depending on how heroin is taken, heroin effects can be felt within 7-8 seconds (injecting) or within 10–15 minutes (snorting or smoking).
The effects of heroin may last for approximately 3–5 hours and the drug dangerously impairs driving skills.
HIV
HIV-infected patients diagnosed with AIDS are on an average 22% slower with reaction time than uninfected controls.
12.2% of non-HIV infected patients who injected drugs and were followed for an average of 4 years, died from traffic accidents.
hypersomnia
Ninety-three (74%) drivers had fatigue while driving; thirty-one (25%) sleepiness; thirty-six (29%) had an accident or near accident; and (35%) had nodding while driving.
Nodding while driving (PR 2.13, IC 1.26-3.59, p < 0.01) was associated with an accident or near accident.
Hypersomnia patients reported more frequently the occurrence of recent car crashes (in the previous 5 years) than in healthy subjects.
This risk that was confirmed in both treated and untreated subjects at study inclusion (Untreated, OR = 2.21 95%CI = [1.30-3.76], Treated OR = 2.04 95%CI = [1.26-3.30]), as well as in all disease categories, and was modulated by subjective sleepiness level (Epworth scale and naps)
However, after patients were treated for at least 5 years the risk of car accidents was not different to healthy subjects (OR = 1.23 95%CI = [0.56-2.69]).
The Epworth Sleepiness Scale (OR = 1.13; 95% CI: 1.07-1.23) was the best predictors for odds showing increased risk of road accidents.
In all, 6,654 (3.4%) had suffered an accident related to sleepiness.
In multivariate regression analysis, Epworth sleepiness scale (ESS) item #8 (falling asleep on the wheel, while stopping for a few minutes in traffic) was closest related to suffering an accident (OR 2.8).
improving driving performance
Docosahexaenoic acid (DHA) supplementation produced significant improvements in complex reaction time (p = 0.004) and complex reaction efficiency (p = 0.003) after 4 weeks treatment in female elite soccer players.
Significant improvements in immediate spatial memory and driving performance were observed after Concord grape juice (CJC) relative to placebo.
Caffeine and napping may improve driving performance.
Modafinil significantly improves steering deviation and Psychomotor Vigilance Task reciprocal reaction time over placebo in driving simulators.
infringement penalties
Drivers had higher risks of crashes following infringement penalties [odds ratio (OR) 1.32; 95% confidence interval (CI) 1.29-1.36], especially crashes when the offender was at fault (1.41; 1.36-1.46).
Crash risk relative to a comparable period was very high for teenage drivers (1.55; 1.34-1.78) and among drivers penalized for dangerous driving (3.19; 2.52-4.03) or driving under the influence of alcohol (1.99; 1.67-2.37).
The risk remained relatively high for more than 6 months after the penalty, but declined steadily over this period.
Suspended or revoked drivers who continue to drive-which appears to be the majority-are about 3 times more likely to be involved in crashes and to cause a fatal crash.
insomnia
Insomniac truck drivers had an almost two-fold risk of driving accidents (OR: 1.82, CI 95%:1.33-2.49) and a more than three-fold increased risk of near-miss accidents (OR: 3.35, CI95%:2.06-5.45) compared to non-insomniac drivers.
Braking reaction time was slower after sleep restriction than after normal sleep (mean, 1.39 seconds vs. 1.22 seconds; P < 0.01).
Having less than 6 hours sleep in the past 24 hours is associated with a 6 fold increase in motor vehicle crash related injuries
legislation
Analysis of traffic-related hospitalization costs enables us to estimate the lower bound of the negative externality related to excessive alcohol consumption.
In this context, electoral dry laws saved Brazil's public healthcare system $100,000 per day.
The highest mortality rates during the period were in males 20 to 29 years of age.
After enactment of the Brazilian Traffic Code, there was a fall of 9.69 deaths/100,000 inhabitants per year for every categories of traffic accidents (p < 0.001), 6.90 for pedestrians (p = 0.001), and 1.96 for vehicle occupants (p < 0.001).
As for age bracket, the greatest influence on mortality was in pedestrians 15 to 19 years of age (p < 0.001) and all victims 20 to 29 years of age (p < 0.001).
Following enactment of the Drinking and Driving Law, there was a reduction in overall and pedestrian mortality.
The rates for motorcyclists and vehicle occupants stabilized.
Lipophilic compounds
Highly lipophilic compounds like some B-blockers, clonidine and other anti-hypertensives, sedating antihistamines, tricyclic antidepressants, benzodiazepine derivatives along with antipsychotics like quetiapine, olanzapine and haloperidol may adversely affect the CNS and reaction times.
liver disease
In Sweden between 1987 and 2015 a 1 L increase in per capita consumption was associated with a 19% increase in cirrhosis mortality.
Minimal hepatic encephalopathy patients (MHE) showed impaired driving ability that correlated with MHE grade, with impaired vehicle lateral control in spite of reduced driving speed.
Patients with MHE also showed psychomotor slowing, longer reaction times, impaired bimanual and visuo-spatial coordination and concentrated attention and slowed speed of anticipation.
Drivers who are categorized as unsafe had made more illegal turns and more crashes on the driving simulator than drivers categorized as safe; a higher proportion of subjects with Minimal hepatic encephalopathy (MHE) were categorized as unsafe drivers at baseline (16%) than subjects without MHE (7%, P=.02), and at 1 year follow up (18% vs 0%, P=.02).
Cessation of alcohol within 1 year and illegal turns during simulator navigation tasks were associated with real-life automobile crashes and MHE on in regression analysis; road edge excursions in the simulator were associated with real-life traffic violations.
MEDICAL CONDITIONS AND MEDICATIONS IMPACTING ROAD SAFETY
In Oman (July 2018),7.6% of the victimized drivers had a history of medical conditions with diabetes and hypertension (36.1% each) being the most common.
Around 4.0% of victims were on medications with insulin being the most common (9.4%).
Loss of control was contributed to 38.5% of cases followed by dizziness (25.6%), sleep amnesia (10.3%), and blurred vision (7.7%).
Other issues blamed by victimized drivers include loss of sensation, vertigo, phonophobia, photophobia, back pain, and headache that accounted for 17.9% of cases.
migraines
Multivariate Cox model has shown a significant association between involvement in motor vehicle crashes and migraine headaches (p = 0.009, chi 2 = 6.91)
Increased odds of subsequent motor vehicle injuries were found for migraines (OR: 1.631, 95% CI: 1.125, 2.364).
Neuroticism
It is noteworthy to mention that neuroticism alone can increase the odds of road accidents by 1.1-fold (P=0.009).
obesity
Longitudinal self-matched cohort analyses suggest that road crash risks are three times higher in morbidly obese drivers than the population norm.
opium
The crude OR of having a crash for opium was 1.94 (95% CI: 1.11-3.38)
parkinsons disease
Progression of Parkinson's disease will result in increased driver reaction times.
Patients with reaction times of 0.88 seconds are considered to be unable to drive vehicles safely on the road.
However those patients with reaction times of 0.68 seconds are considered to be capable of driving cars safely on the road.
When the rates of major car accidents before and after the onset of Parkinsons Diseases were compared, 15 patients had experienced a major car accident resulting in human injury or serious property damage since the commencement of Parkinsons Disease.
Moreover, this ratio was 4.3 (95% CI 1.9-9.7).
The occurrence of accidents after the onset of Parkinsons Disease was correlated with age, disease duration, levodopa equivalent dose, cognitive function (MMSE, MoCA-J), but not motor symptom score (UPDRS part III at the time of the study).
The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP) score was also greater in patients with major car accidents.
Severity of symptoms (Hoehn-Yahr classification), cognitive function, and disease duration were predictable risk factors for car accidents.
However, motor symptom score (UPDRS part III) was not associated with the incidence of major car accidents.
In addition to a low cognitive function and the severity of symptoms, the QUIP score may be an independent factor that can be referenced when advising Parkinsons Disease patients to refrain from driving.
Pedestrians
Secondary analysis showed that pedestrians had higher odds of mortality death (Odds Ratio, OR: 2.08, 95% CI: 1.63, 2.66,
When exclusively analysing pedestrians, it was found that motorcycles were responsible for pedestrian deaths in 9.1% of the fatalities while this figure was 5.5% for pedestrians in other age groups killed in a traffic accident (P < 0.05).
Among 16,458 pedestrians, 48 medicine classes of medicines possessed a positive association for an increased risk of crash, with median odds ratios ranging from 1.12 to 2.98.
Benzodiazepines and benzodiazepine-related drugs, antihistamines, and anti-inflammatory and antirheumatic drugs were among the 10 medicines most consumed.
Although years of life lost (YLL) among 1000 male pedestrians was reduced from 2.5 in 2009 to 1.5 in 2013, it increased from 0.9 to 2.1 among 1000 females during the same period.
Higher proportion of death was found in female, illiterate, and married pedestrians (p < 0.001).Furthermore, mortality was higher in pedestrians living in the cities, during daytime, at home, and in hospitals (p < 0.001).
514 pedestrian accidents in Tehran CIty were evaluated where the site of accidents included arterial streets in 370 (71.9%) cases, collector streets in 133 cases (25.2%) and highways in 11 cases (2.1%).
Geographical units of traffic accidents in pedestrians had statistically significant relationship with the number of crossroads, number of bus stations, and recreational areas.
Neighbourhoods near markets are considered as the most dangerous places for injury in traffic accidents.
perianal disease
Multivariate Cox model has shown a significant association between involvement in motor vehicle crashes perianal diseases (p = 0.006, chi 2 = 7.44).
physicians warnings reduce accident crashes
Patients' motor vehicle crash frequency decreased from 11.78 to 8.17 events per 1,000 patients per year after a physician warning, which corresponded to a relative risk of 0.69 (95% CI, 0.59-0.81; P < .001).
Psychiatric hospitalization frequency increased from 147 to 289 events per 1,000 patients per year corresponding to a relative risk of 1.97 (95% CI, 1.91-2.03; P < .001).
Risk Factors for Serious Road Accidents
On a national scale, being a professional driver [incidence rate ratio (IRR): 1.10, 95% CI: 1.02-1.19], fatigue (IRR: 1.15, 95% CI: 1.03-1.29), large vehicle type (IRR: 1.11, 95% CI: 1.03-1.21), overload (IRR: 1.09, 95% CI: 1.03-1.16), and terrain (IRR: 1.09, 95% CI: 1.01-1.18) were significantly associated with extremely serious road accidents in China.
SEAT BELT USAGE
A Korean 7-year retrospective review of data was conducted for 419 patients with facial trauma that occurred due to a motor vehicle accident.
Patients who utilised a seat belt faced a lesser risk of severe soft-tissue injury in comparison with having mild soft-tissue injury than patients who did not use a seat belt (P=0.0129).
Furthermore, patients who used a seat belt had a smaller risk of accompanying facial bone fracture necessitating surgical operation than patients who didn’t use a seat belt (P=0.0168).
With regard to facial bone fracture according to seat location, patients who sat in the back seat had a greater risk of accompanying facial bone fracture than patients who sat in the passenger's seat (P=0.0392).
In terms of facial bone breakages that required a surgical operation, patients who had sat in a back seat faced greater risk of requiring a surgical operation than patients who sat in the driver's seat (P=0.0479).
sex differences
Male reaction time is consistently faster than females.
The female menstrual cycle may impact on driver performance.
SIGNS AND SYMPTOMS THAT PREDICT DRUG CATEGORY OF DRUG IMPAIRED DRIVERS
Thirteen signs and symptoms of drug impaired drivers include: mean pulse rate, condition of the eyes, condition of the eyelids ,eyelid tremors, pupil size in darkness, reaction to light, being under the care of a doctor or dentist, assessment of horizontal gaze nystagmus (HGN), convergence, performance on the One Leg Stand (OLS) Test, presence of visible injection sites, systolic blood pressure, and muscle tone.
Indicators related to the appearance and physiological response of the eye contributed the most to the prediction of drug category, followed closely by clinical indicators and performance on the psychophysical tests.
sleep apnoea
Sleep apnoea subjects demonstrated significantly increased steering deviation and crashed more frequently than control subjects in a driving simulator.
Obstructive Sleep apnoea is associated with a higher risk of a motor vehicle accident (risk ratio of 2.45 compared to controls (P<0.001).
However CPAP use>4 hours/night was associated with a reduction of motor vehicle accident incidence (7.6 to 2.5 accidents/1,000 drivers/year).
After 3 years of CPAP therapy for obstructive sleep apnoea, motor vehicle accident rate fell to the same rate as the control group.
The percentage of traffic accidents was respectively 17.1% (19/111) in obstructive sleep apnoea hypopnea syndrome (OSAHS) and 4.1% (29/712) in non-OSAHS (P<0.001).
Multiple logistic regression analysis showed that sleepiness (OR=30.578, 95%CI: 10.699-87.394; P<0.001), OSAHS (OR=14.062, 95%CI: 4.791-41.269; P<0.001) and vehicle years (OR=2.345, 95%CI: 1.183-4.646; P<0.05) were the risk factors, while the average night sleep time (OR=0.037, 95%CI: 0.014-0.098; P<0.001) was the protective factor.
Daytime somnolence is of particular concern for commercial vehicle drivers, whose crash risk increases 50% with untreated Obstructive Sleep Apnoea.
Suffering from apnoea (OR = 4.89; 95% CI: 1.07-23.83) was among the best predictors for odds showing increased risk of road accidents.
The Berlin questionnaire established that in 1400 male bus drivers a total of 1058 (75.6%) drivers had one or more accidents while driving bus.
176 (12.6%) drivers were found to have high Obstructive Sleep Apnoea (OSA) risk and the accident rate was 83.0% in high-risk group compared with 74.5% of low-risk drivers who had accidents (p=0.043).
Drivers with a history of traffic accident were older (p=0.030), had higher ESS (p=0.019), and were more in the high-risk OSA group according to the Berlin questionnaire (p=0.015).
In multivariate linear regression analysis, traffic accident was associated with only Berlin questionnaire (p=0.015).
smokers
Logistic regression analysis found that the overall odds for collision involvement in the preceding year among current smokers for 2002-2014 was 1.27 (95% CI: 1.06-1.53) times that of non-smokers.
Social factors
Extroversion, psychopathy, neuroticism and time hurrying (impatience) were significant factors associated with road traffic accidents in bus drivers (adjusted OR: 1.268, 95% CI: 1.133-1.419; adjusted OR: 1.177, 95% CI: 1.028-1.347; adjusted OR: 1.092, 95% CI: 1.005-1.187; adjusted OR: 1.123, 95% CI: 1.025-1.230, respectively).
Reduced serum levels of 5-HT and 5-HTP were significantly associated with the incidence of road traffic accidents (adjusted OR: 0.985, 95% CI: 0.973-0.997; adjusted OR: 0.982, 95% CI: 0.969-0.994, respectively).
In the psychosocial model of driving behavior (including mistakes ,lapses, and intentional violations) and accidents, psychological factors, depression (P < 0.02), personality trait of conscientiousness (P < 0.02), failure schema due to the parenting style of mother (P = 0.001), and perception of police commands (P < 0.002), all played a significant role in predicting driving behavior.
Among social factors, perception of police regulations (P = 0.003), had an important effect on violations and mistakes.
Among environmental and behavioral factors, major factors such as drug and alcohol use (P = 0.001,) driving age (P = 0.001), having driver's license (P = 0.013), records of imprisonment or committing a crime (P = 0.012) were also able to predict occurrence of accidents.
stimulants
Cocaine, amphetamines such as speed (amphetamine sulphate) as well as ice (crystal methamphetamine hydrochloride), methiopropamine, methylenedioxymethamphetamine (MDMA, ecstasy) lysergic acid diethylamide (LSD) may adversely affect driving skills.
The crude OR of having a crash for metamphetamine is 5.5 (95% CI: 1.21-24.81).
stroke
Only 1 of 3 case-control studies showed a relationship between stroke and Motor Vehicle Collisions.(MVC:OR 1.9, 95% CI 1.0-3.9).
Of 5 cohort reports, only one study, limited to self-report, found a higher risk of MVC associated with stroke or transient ischemic attack TIA (RR 2.71, 95% CI 1.11-6.61).
2 of 4 cross-sectional studies using computerized driving simulators identified a more than 2 -fold risk of MVCs among stroke victims compared with controls.
The difference in one study was restricted to those with middle cerebral artery stroke.
After a stroke, road sign recognition was better in people who underwent training in a simulator-based driving rehabilitation program compared with control (mean difference 1.69 points on the Road Sign Recognition Task of the Stroke Driver Screening Assessment, 95% CI 0.51 to 2.87, P = 0.007).
surgery
For patients undergoing surgery for lumbar disc herniation, those with a right-side radiculopathy obtained a significant improvement in Driver Reaction Time from 664 ms (preoperative), to 593 ms at 5 weeks after surgery (P<0.05).
Those patients with a left-side radiculopathy, improved from 675 ms preoperative to 619 ms.
Control subjects had a driving reaction time of 487 ms, which differed significantly from patients at all three testing times (p<0.001).
Reaction times improved after surgery for disc herniation in patients with preoperative paresis.
A significant improvement of driver reaction time after surgery was seen in patients with left- and right-sided pareses (p<.005).
Four weeks after minimally invasive primary total hip arthroplasty surgery, patients improved their reaction times by 0.035 s (p = 0.0398) and most patients should be allowed to return to driving.
After 8 days, postoperative total brake response time increased significantly by 30% in right total knee arthroplasty (TKA) and insignificantly by 2% in left TKA.
Brake force significantly worsened by 35% in right TKA and by 25% in left TKA during this time.
Baseline values were reached at week 12 in right TKA; the impairment of outcome measures, however, was no longer significant at week 6 compared with preoperative values.
Total brake response time and brake force in left TKA fell below baseline values at weeks 6 and 12.
Brake force in left TKA was the only outcome measure that was significantly impaired 8 days postoperatively
A longitudinal patient cohort (n= 27) was tested preoperatively and after first follow-up of spinal surgery.
A cross-sectional cohort (n= 27) was tested at > 1 year postoperatively.
Results from these groups were compared with a healthy age-matched control group of 24 volunteers.
No significant improvement in Reaction time, foot transfer time (together brake response time [BRT]) BRT was seen in lumbar fusion 3 months postoperatively (p= 0.597);
Brake Force was even weaker than preoperatively (p= 0.044).
In contrast to the control group (median BRT 479 ms), preoperative BRT was already impaired in lumbar fusion patients (median 560 ms), representing a greater braking distance of 2.25 m at 100 km/h.
Most patients performed satisfactorily, around one third presented critical braking performance.
Risk factors for impaired braking may include scheduled multisegmental fusion surgery, female sex, and pain.
synthetic cannabinoids
UR-144 causes effects and impairment similar to or even more hazardous than delta-9 tetrahydocannabinol (Δ (9)-THC) making it unsafe for driving.
XLR-11 was quantified at 1.34 ng/ ml to cause driver impairment.
Synthetic cannabinoids like UR-144 and XLR-11 may also impair driving ability.
TOXOPLASMA GONDII INCREASES TRAFFIC ACCIDENTS
A meta-analysis of 5 out of 9 studies concluded that Toxoplasm gondii significantly increased the risk of having traffic accidents.
There was no significant difference found between people aged under 45 or those aged over 45 years of age.
vehicle manoeuvre
Based on the results from multivariate conditional logistic regression, significant associations between vehicle manoeuvre (OR Turn to right or left / Moving forward = 11.10, 95%CI: 1.77-69.58, P = 0.01) and age (OR = 1.11, 95%CI = 1.004-1.22, P = 0.04) with the chance of being at fault driver were found.
WILLINGNESS TO PAY FOR MORTALITY REDUCTION
Myanmar in 2015 had a resulting median and mean for the value of statistical life (VSL) of MMK 118.062 million (US$ 98,385) and MMK 162.854 million (US$ 135,712), respectively.
Total cost of death was assessed to range from MMK 594.681 billion (US$ 495.567 million) to MMK 820.296 billion (US$ 683.580 million) in 2015.
Willingness to pay was found to be significantly related to education, age, family status, occupation, individual income, household income, the vehicle used, exposure to traffic, drunk driving, personal experiences, and the perceived risk of traffic accidents.
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