190923 Trail-making-test-B and driver screening in the emergency department

Tuesday, October 28, 2008

Marian E. Betz, MD, MPH , Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
Jonathan Fisher, MD, MPH , Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
BACKGROUND: Emergency departments (EDs) rarely screen for elderly driving safety. The Trail-Making-Test-B (TMT-B) is a neuropsychological test that may predict ability. We examined (1) the driving patterns of elderly ED patients and (2) the feasibility of TMT-B use in an ED.

METHODS: We administered the TMT-B and a survey of health status and driving habits to a convenience sample of ED patients, excluding those with altered mentation, critical illness, or language barriers. The TMT-B, scored by the time of first attempt, requires connection of letters and numbers in sequence on paper, and a time >180 seconds may suggest elevated driving risk.

RESULTS: Of 129 patients ages 18 to 95, 94(72.9%) were current drivers, and 88 (93.6%) of drivers completed the TMT-B. 41.5% of drivers were elderly (65+). The mean TMT-B completion time was 86(SD=64) seconds among all drivers and 116(SD=82) seconds among elders. In linear regression, times did not differ by sex or health but increased with age(b= 1.32, p<0.001), as in prior studies. 6.8%(95%CI;1.4-12.2%) of all drivers and 13.9%(95%CI;2.0-25.8%) of elderly drivers required >180 seconds for the TMT-B. 88.9% of elderly drivers rated their ability as good or excellent and 19.4%(95%CI;5.9-33.0%) reported a collision/ near-collision within a year. In logistic regression, neither TMT-B performance nor being elderly predicted a recent collision.

CONCLUSIONS: Many elderly ED patients drive, and relatively healthy ED patients are able to complete the TMT-B with results similar to standard nomograms. The TMT-B may prove useful as part of targeted driver screening programs in EDs.

Learning Objectives:
1. Recognize that there are elderly drivers seen as patients in emergency departments who may be at risk for collisions 2. Describe the administration of the trail-making-test-B and its potential use for driver screening. 3. Evaluate the feasibility of using the trail-making-test-B in an emergency department environment 3.

Keywords: Emergency Department/Room, Motor Vehicles

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a board-eligible emergency physician with a Masters in Public Health and prior research and teaching experience in injury prevention and control.
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.