179127 Clock Drawing as a Predictor of Driving Risk in Older Emergency Department Patients

Sunday, October 26, 2008

Sherwin Yen, BS , School of Medicine, Case Western Reserve University, Cleveland, OH
Hana Choy, MD , School of Medicine, Case Western Reserve University, Cleveland, OH
Fredric Hustey, MD , Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, OH
Objective: To determine whether performance on a Clock Drawing Test (CDT) is associated with Adverse Motor Vehicle Events (AMVE) in elderly emergency department (ED) patients; to determine whether abnormal CDT scores are associated with inaccuracies in self-reporting police-related AMVE. Background: The American Medical Association recommends CDT for driving-related skill assessment. However, its relationship to driving risk is still unclear. Methods: Participants: convenience sampling of ED patients 65 years or older with valid driver's license over an 18 month period. Screening: CDT (Schulman method) using standardized cutoff scores. Measurements: Number of AMVE were determined by: 1. self-report and 2. state records. AMVE were defined as motor vehicle accidents or moving violations. Paired T-tests were used to determine differences between reported (self-report) and actual (state recorded) events. Results: 135/149 participants were available for analysis. 36% (49/135) had abnormal CDT. Participants with normal CDT drove more frequently than those with abnormal CDT (2.82 vs. 2.44 miles/wk P=.079). There was no difference in number of state confirmed events/miles driven between participants with normal and abnormal CDT (.051 vs. .051 events/mi/wk P=.50). Participants with both normal and abnormal CDT scores self-reported fewer numbers of AMVE involving police than state confirmed events (.02 vs. .05 events/mi/wk P=.09) and (.007 vs. .03 events/mi/wk P=.14) respectively. Conclusion: Abnormal CDT scores were not associated with AMVE or with higher rates of underreporting of AMVE involving police. CDT may not be an effective tool for the assessment of driving risk in elderly ED patients.

Learning Objectives:
Evaluate the effectiveness of the Clock Drawing Test as an indicator of driving safety in elderly patients. Recognize that patients with abnormal clock drawing test may not be more likely to inaccurately report adverse motor vehicle events than those with normal clock drawing tests

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a 4th year medical school studnet MD/MPH candidate at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and have been involved in the enrollment of these subjects, the data analysis, and am the primary author.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.