Evidence Based Review of Fitness-to-Drive and Return-to-Driving Following Traumatic Brain Injury

The purpose of this study was to conduct an evidence-based review to determine predictors of fitness to drive and return to driving in persons with traumatic brain injury (TBI). Relevant databases (MEDLINE/PubMed, CINAHL, Cochrane Library, and SCOPUS) were searched for primary articles published before June 2016 using MeSH search terms. Using the American Academy of Neurology’s classification criteria, 24 articles were included after reviewing 1998 articles. Studies were rated by class (I–IV), with I being the highest level of evidence. Articles were classified according to TBI severity, as well as types of assessments (on-road, simulator and surveys). There were no Class I studies. Based on Class II studies, only Post-traumatic amnesia (PTA) duration was found to be probably predictive of on-road driving performance. There is limited evidence concerning predictors of return to driving. The findings suggest further evidence is needed to identify predictors of on-road driving performance in persons with TBI. Class I studies reporting Level A recommendations for definitive predictors of driving performance in drivers with TBI are needed by policy makers and clinicians to develop evidence-based guidelines.