Original articlePancreas, biliary tract, and liverIn Patients With Cirrhosis, Driving Simulator Performance Is Associated With Real-life Driving
Section snippets
Patients
In total, 205 patients with liver cirrhosis were prospectively enrolled after informed consent at Virginia Commonwealth University Medical Center between November 2008 and April 2014. The inclusion criteria were age 18–65 years, current car driver, no overt mental impairment (Mini-Mental Status Examination >25), and liver cirrhosis diagnosed by biopsy or unequivocal evidence of decompensation (history of ascites, variceal bleeding) or presence of cirrhosis/varices on radiologic examinations.
Results
Baseline characteristics of the 205 recruited subjects are shown in Table 1.
Discussion
In this largest-studied cirrhosis cohort, we found that MHE diagnosed using paper-pencil tests negatively impacts on simulated driving skills and is associated with more real-life crashes and traffic violations at baseline and at 1 year compared with those without MHE,9, 15 which was corroborated with traffic records. We found that these real-life crashes and traffic violations are also linked to impaired driving simulator performance that remained stable over a year’s follow-up. Furthermore,
References (24)
Neuropsychological characterization of hepatic encephalopathy
J Hepatol
(2001)- et al.
Patients with minimal hepatic encephalopathy have poor insight into their driving skills
Clin Gastroenterol Hepatol
(2008) - et al.
Hepatic encephalopathy: definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998
Hepatology
(2002) - et al.
What is driving the legal interest in hepatic encephalopathy?
Clin Gastroenterol Hepatol
(2011) - et al.
Legal ramifications for physicians of patients who drive with hepatic encephalopathy
Clin Gastroenterol Hepatol
(2011) Legal responsibilities of physicians when they diagnose hepatic encephalopathy
Clin Liver Dis
(2015)- et al.
Hepatic encephalopathy treatment and its effect on driving abilities: a continental divide
J Hepatol
(2015) - et al.
Attention, memory, and cognitive function in hepatic encephalopathy
Metab Brain Dis
(2005) - et al.
Minimal hepatic encephalopathy: diagnosis, clinical significance and recommendations
J Hepatol
(2005) - et al.
The continuous reaction times method for diagnosing, grading, and monitoring minimal/covert hepatic encephalopathy
Metab Brain Dis
(2013)
Characteristics of minimal hepatic encephalopathy
Metab Brain Dis
Minimal hepatic encephalopathy characterized by parallel use of the continuous reaction time and portosystemic encephalopathy tests
Metab Brain Dis
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Social Impact of Hepatic Encephalopathy
2024, Clinics in Liver DiseaseThe Health Care Burden of Hepatic Encephalopathy
2024, Clinics in Liver DiseaseEASL Clinical Practice Guidelines on the management of hepatic encephalopathy
2022, Journal of HepatologyCitation Excerpt :Two studies found no increased rate of accidents in patients with cirrhosis and covert HE181,182 and patients with covert HE may not be unsafe drivers in reality.183 Nevertheless, treatment with rifaximin in a randomised trial has been shown to improve driving simulator performance in patients with covert HE.184,185 There are no clear published guidelines on driving for patients with covert HE with or without recent overt HE.
Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy
2022, Clinical Gastroenterology and HepatologyCitation Excerpt :Perhaps an additional contributor to socioeconomic stability and earning ability is the impairment of driving skills observed in HE. Performance on driving simulations, and on actual driving assessments, is impaired in the presence of CHE and OHE.92–94 Yet, most patients are often unaware of their driving deficits and have confidence in driving ability that is discordant with their performance and the observed performance reported by family or friends.93,94
Systematic review of driving simulator validation studies
2019, Safety ScienceCitation Excerpt :The other factor that impacts the comparison of simulated and real driving is the operational definition of “real-world” driving. Several approaches are evident in the literature, including self-reported driving behaviour (e.g., Ba et al., 2016; Szlyk et al., 1992), allied health assessments (e.g., Lauridsen et al., 2016; van Wolffelaar et al., 1988), and on-road drives in instrumented vehicles (e.g., Helland et al., 2016; Lauer and Suhr, 1958). These techniques use diverse variables to compare driving performance; involving both physical (e.g., lane deviation, speed, reaction time, crashes) and cognitive (e.g., cognitive load, divided attention, situation awareness) driving behaviours (Caird and Horrey, 2011).
Conflicts of interest The authors disclose no conflicts.
Funding The project was partly supported by Veterans Administration Merit Review CX001076, by RO1AA020203 from the National Institute on Alcohol Abuse and Alcoholism, by grant RO1DK087913 from the National Institute of Diabetes and Digestive and Kidney Diseases, and by the McGuire Research Institute.