Clinician assessment of the driving competence of patients with dementia.
Clinician assessment of the driving competence of patients with dementia.
复制标题
临床医生对痴呆症患者驾驶能力的评估。
DOI：
10.1111/j.1532-5415.2005.53265.x
复制
发表时间：
2005
影响因子：
6.3
通讯作者：
Morris,JohnC
中科院分区：
文献类型：
--
作者：
Ott,BrianR;Anthony,David;Papandonatos,GeorgeD;D'Abreu,Anelyssa;Burock,Jeffrey;Curtin,Alicia;Wu,Chuang-Kuo;Morris,JohnC
目的：探讨临床医师评定轻度痴呆患者驾驶能力的效度和信度。设计：基于不同专业知识和经验的临床医生的图表回顾，对轻度痴呆司机的横截面进行观察性研究。地点：痴呆症门诊。参与者：来自驾驶和痴呆的纵向研究的50名痴呆受试者。测量：每位临床医生回顾了来自临床图表和第一次研究访问的信息。然后，临床医生将司机分为安全、边缘或不安全。一位专业驾驶教练将这些评分与标准化道路测试的总驾驶分数和驾驶能力的分类评分进行比较。临床医生还完成了一个视觉模拟量表评估变量，导致他们的驾驶能力的决定。结果：临床医生评分的准确性范围从62%到78%的讲师的安全与边缘或不安全的整体评级。一般来说，有中等的准确性和相互可靠性。通过更多地关注痴呆持续时间和严重程度评分，以及减少对病史和体格检查的依赖，可以提高最不准确评分者的准确性。最准确的预测者是在痴呆症评估方面受过专门培训的临床医生，他们不一定是多年临床经验最丰富的医生。结论：尽管临床医生可能能够识别出许多潜在的危险驾驶员，但准确性不足以表明仅凭临床医生的评估就足以确定轻度痴呆患者的驾驶能力。
Objectives:To determine the validity and reliability of clinician ratings of the driving competence of patients with mild dementia.Design:Observational study of a cross‐section of drivers with mild dementia based on chart review by clinicians with varying types of expertise and experience.Setting:Outpatient dementia clinic.Participants:Fifty dementia subjects from a longitudinal study of driving and dementia.Measurements:Each clinician reviewed information from the clinic charts and the first study visit. The clinician then rated the drivers as safe, marginal, or unsafe. A professional driving instructor compared these ratings with total driving scores on a standardized road test and categorical ratings of driving competence. Clinicians also completed a visual analog scale assessment of variables that led to their determinations of driving competence.Results:Accuracy of clinician ratings ranged from 62% to 78% for the instructor's global rating of safe versus marginal or unsafe. In general, there was moderate accuracy and interrater reliability. Accuracy could have been improved in the least‐accurate raters by greater attention to dementia duration and severity ratings, as well as less reliance on the history and physical examination. The most accurate predictors were clinicians specially trained in dementia assessment, who were not necessarily the most experienced in their years of clinical experience.Conclusion:Although a clinician may be able to identify many potentially hazardous drivers, accuracy is insufficient to suggest that a clinician's assessment alone is adequate to determine driving competence in those with mild dementia.