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Health: Stroke Victims

GPs reminded of obligations if stroke survivors want to drive

About a quarter of acute stroke survivors younger than 65 go back to driving too soon.

And 15% of these have a cognitive deficit, according to findings from one of the few Australian studies to examine stroke and driving.

National Stroke Foundation and Austroads guidelines recommend that patients stop driving for at least one month after acute stroke and for two weeks following a TIA.

Most patients are aware of the restrictions, but many choose to ignore them, The Psychosocial Outcomes in StrokE (POISE) study shows more than half of stroke survivors aged 18 to 65 years who resume driving early recall being given advice not to do so.

"This is a really important issue for GPs, who have an obligation to inform patients when their illness, injury or disability affects their ability to drive safely," says Dr Sara Bird, manager of medico-legal and advisory services with MDA National.

"GPs do not have an obligation to inform their licensing authorities that a patient should not be driving for a month," she says.

But if a patient says they will continue to drive despite advice not to do so, then the doctor does have a responsibility to alert the licensing authority.

"If patients are unsafe to drive then there would be that obligation."

In the case of commercial drivers the recommended driving moratorium is three months.

The POISE study, of 440 people younger than 65 who survived acute stroke after admission to one of 20 NSW public hospitals, has found those taking up driving ahead of schedule are likely to be men and the main breadwinner of the household.

"Driving early may be necessary in order to maintain job security," they say.

"Irrespective of the advice given, there is evidence indicating that people self-regulate their driving according to how they perceive their fitness to drive," the authors write in the International Journal of Stroke.

"It is concerning that 15% of returned drivers were cognitively impaired on objective testing," they say.

They call for clear protocols for advising patients on driving resumption. This is particularly important because stroke in younger adults now accounts for one third of the burden of such events worldwide.

Even though all of the 359 study participants were admitted to a stroke unit with a full medical, nursing and allied health team, almost half of the early returners did not recall being told to avoid driving for a month.

"It is possible that staffs are unclear about who is responsible for discussing or evaluating fitness to drive, and when this should occur," the researchers say.

Dr Bird says it is an issue for GPs to be alert to when patients are returning from the ED.

"It is clearly in the public interest if you have an unsafe driver on the road, not only are they going to kill and maim themselves, they are potentially going to kill and maim other members of the community," she says.

"It is an issue to be mindful of, because it may well be that the patient has not been told ... not remembered, or possibly been told and chosen not to remember."

The authors, from the George Institute for Global Health, say its logical that assessment of fitness to drive should be done before hospital discharge.

Contributed by Carmel Sparke Medical Observer - medical news, opinion and analysis



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