• Sandy Leproust, Emmanuel Lagarde, and Louis-Rachid Salmi.
• INSERM, U897, Equipe Avenir Prévention et prise en charge des traumatismes, Bordeaux, France.
• J Gen Intern Med. 2008 Nov 1; 23 (11): 179618031796-803.

BackgroundMany countries have initiated legislation to detect individuals who are unfit to drive, without any evidence that positive effects of these screening procedures outweigh negative effects.ObjectiveTo measure the potential effectiveness of a screening program to detect individuals unfit to drive.DesignMarkov decision analysis was used to compare no screening to two potential screening strategies.ParticipantsHypothetical cohorts of 10,000 45-year-old, 65-year-old, 75-year-old and 85-year-old individuals seen in primary care practices.InterventionsWithin the screening strategies: a clinical test without on-road confirmatory testing; a clinical test with on-road confirmatory testing, and an imposed driving cessation for patients with a positive test.MeasurementsFor each strategy, we compared for two conditions (sleep disorders and dementia) the numbers of crash-related consequences prevented and of adverse events induced (primary objective) and measured the gain in quality-adjusted life years (secondary objective).ResultsFor sleep disorders, on-road confirmatory annual testing was the preferred strategy. Whatever the medical condition and age when screening starts, no screening was always better than single-test screening without an on-road confirmatory testing. In sensitivity analyses, these baseline conclusions were only affected by extreme values of test specificity.ConclusionBecause of the expected difficult application and cost of road tests and annual screening by clinicians, the most acceptable strategy from public health, clinical, and individual points of view is likely to be no screening.

17 keywords...

hide…