• M J Rapoport, K Weegar, Y Kadulina, M Bédard, D Carr, J L Charlton, J Dow, I A Gillespie, C A Hawley, S Koppel, S McCullagh, F Molnar, M Murie-Fernández, G Naglie, D O'Neill, S Shortt, C Simpson, H A Tuokko, B H Vrkljan, and S Marshall.
• From the Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada, University of Toronto, Toronto, ON M5S 2J7, Canada.
• QJM. 2015 Nov 1; 108 (11): 859-69.

BackgroundMedical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised.AimTo systematically evaluate the quality of selected national guidelines about driving with medical illness.DesignA literature search of bibliographic databases and Internet resources was conducted to identify the guidelines, each of which was formally appraised.MethodsEighteen physicians or researchers from Canada, Australia, Ireland, USA and UK appraised nine national guidelines, applying the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.ResultsRelative strengths were found in AGREE II scores for the domains of scope and purpose, stakeholder involvement and clarity of presentation. However, all guidelines were given low ratings on rigour of development, applicability and documentation of editorial independence. Overall quality ratings ranged from 2.25 to 5.00 out of 7.00, with modifications recommended for 7 of the guidelines. Intra-class coefficients demonstrated fair to excellent appraiser agreement (0.57-0.79).ConclusionsThis study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.© The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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