Dr. Young
Clinical question: Do patients with first syncopal events suffer more motor vehicle collisions (MVCs) than patients without syncope?
Background: Recommendations for driving restrictions after an initial episode of syncope depend on the suspected cause of syncope and local guidelines. Given the relative incidence of syncope, this study examines whether we should continue to affect patients through these restrictions.
Study design: A retrospective, observational, cohort study
Setting: Six emergency departments (EDs) in British Columbia (BC), Canada
Synopsis: The use of universal health insurance records and a singular car insurance provider in BC allowed authors to review a population of 43,589 patients and compare MVC incidence between patients with first episodes of syncope and matched controls in the ED.
The primary outcome of MVC was less likely in patients with all causes of likely or definite syncope (HR 0.89; 95% CI, 0.81-0.98). Most of the likely or definite syncopal events were deemed vasovagal in nature (74.3%), which does not always necessitate driving limitations. However, subgroup analysis did not demonstrate that cardiogenic syncope (6.3%) conveyed increased risk.
Of note, the non-syncope controls had a baseline higher utilization of benzodiazepine and opiate prescriptions (9.1 versus 6%, and 14.6 versus 8.1%, respectively) as well as an increased number of prior citations and MVCs (30.9 versus 26.9% and 27 versus 25.4%, respectively).
Bottom line: Patients diagnosed with likely first episode of syncope may not need driving restrictions, but further study focusing on cardiogenic syncope may be indicated.
Citation: Staples JA, et al. Syncope and the risk of subsequent motor vehicle crash: a population-based retrospective cohort study. JAMA Intern Med. 2022;182(9):934-42.
Dr. Young is an assistant professor of medicine at the University of Virginia School of Medicine, Charlottesville, Va.