A practical decision tree for assessing fitness to drive in people with epilepsy has been shown to be effective in removing some of the subjectivity inherent in certification by treating doctors.
The decision tree streamlines the assessment into 13 yes/no questions consistent with Australian fitness to drive standards.
A pilot study compared the findings of usual annual medical reviews in 253 people with epilepsy and use of the decision tree performed by the same doctors.
Data from the returned decision tree forms was entered by non-medical staff at the driver licensing authorities in NSW and Victoria and used to recommended periods of seizure freedom for individual patients.
The average time required for doctors to complete the decision tree was 5.4 minutes. Most were completed by GPs.
The study found while all drivers were considered fit to drive by their doctors at medical review, only 88% were fit to drive based on the decision tree.
About 6% of people were considered unfit to drive, 4% were referred for further review and 2% of returned forms were unusable.
Most disagreements between the output of the decision tree and the doctor’s initial assessment were related to the time since last seizure (50%) or planned medication withdrawals (31%).
“Five patients were considered by their physician fit to continue driving despite planned withdrawal of therapy, and two were considered fit despite the physician considering that the factor provoking their last seizure was likely to recur,” the study said.
“A further patient had seizures that the physician felt did not impair consciousness and therefore did not render the driver unfit, but it had not been verified by witnesses or video‐electroencephalographic monitoring, as required by the national standards.”
“One driver had been involved in a crash due to a seizure within the past 12 months. None of these drivers met the published standards, and their physicians did not offer any comment as to why they should be allowed to drive.”
Author of the paper Associate Professor Ernest Somerville, representing the Driving Committee of the Epilepsy Society of Australia, told the limbic that doctors were often “liberal” towards their patient’s wishes to keep driving.