Longitudinal Assessment of Post-concussion Driving in Young Adults (LAPDYA)

项目摘要/摘要 美国每年发生的脑震荡超过380万例。只有44%的脑震荡患者 在受伤后的任何时候减少驾驶，尽管对脑震荡后驾驶的紧急担忧 安全，有记录的驾驶损伤，以及脑震荡后感觉不安全驾驶的报告。多数 脑震荡患者只会在受伤后24-48小时内减少驾驶。开车是一种 需要视觉、运动和认知技能的高度复杂的活动，这些技能通常在 脑震荡。脑震荡患者在受伤和出现的48小时内更频繁地越过中心线 在整个症状恢复过程中，车辆控制较差。然而，脑震荡后的时间进程 驾驶障碍还没有被描述出来。迫切需要1)确定脑震荡的时间 个人应该回到驾驶和2)确定关键的脑震荡评估预测准备 继续开车吧。在没有正式建议的情况下，脑震荡受损的司机有可能 他们自己和其他人在路上。第一个具体目标是比较模拟驾驶和脑震荡 在五个纵向时间点上，个体和非脑震荡的颈椎匹配对照组(损伤前基线， 第二天、第四天、无症状和无限制的医疗许可)和从第二天到第二天的每日自然驾驶 第9天.驾驶建议必须是适当的，并且必须是脑震荡损伤所必需的，因为 过于严格的建议错误地剥夺了脑震荡患者的独立性，并可能 劝阻个人不要寻求医疗服务。第二个具体目标是确定广泛使用的 预测脑震荡个体模拟驾驶行为的脑震荡评估结果 在整个脑震荡恢复过程中。为了达到这些目标，100名脑震荡患者和100名颈椎患者进行了匹配对照 年轻的成年大学生运动员将完成模拟驾驶评估和强烈的脑震荡 在受伤前基线、第2天、第4天、无症状和无限制的医疗许可时评估电池。 自然驾驶(用车载全球定位系统测量)将从第2天到第9天(第7天)被捕获 总天数)。这项研究将确定脑震荡后驾驶的急性和亚急性时间进程 并确定脑震荡后驾驶性能的关键预测因素。这一创新的结果 这种方法将产生广泛和积极的影响，将改善脑震荡患者和 指导卫生专业人员的实践，为研究人员未来的工作提供信息，以及 通过提供以证据为基础的管理后管理建议，充实政策制定者的工作 脑震荡驾驶。

PROJECT SUMMARY/ABSTRACT Upwards of 3.8 million concussions occur annually in the United States. Only 44% of concussed individuals reduce their driving at any point following injury despite emergent concerns over post-concussion driving safety, documented driving impairment, and reports of feeling unsafe driving after a concussion. Most concussed individuals who reduce their driving only do so for 24-48 hours following the injury. Driving is a highly complicated activity that requires visual, motor, and cognitive skills, which are commonly impaired after concussion. Concussed individuals cross the centerline more frequently within 48 hours of injury and present with poorer vehicle control throughout the full symptom recovery. Yet, the time course of post-concussion driving impairment has not been characterized. There is a critical need to 1) determine when concussed individuals should return to driving and 2) identify the key concussion assessment predictors of readiness to return to driving. In the absence of formal recommendations, impaired concussed drivers are at risk to themselves and others on the road. The first specific aim is to compare simulated driving between concussed individuals and non-concussed yoked matched controls across five longitudinal timepoints (pre-injury baseline, day 2, day 4, asymptomatic, and unrestricted medical clearance) and daily naturalistic driving from day 2 to day 9. Driving recommendations must be appropriate and necessitated by concussion impairments, since excessively strict recommendations wrongfully strip concussed patients of their independence and may dissuade individuals from seeking medical care. The second specific aim is to identify widely used concussion assessment outcomes that predict simulated driving performance among concussed individuals throughout concussion recovery. To address these aims, 100 concussed and 100 yoked matched control young adult college athletes will complete a simulated driving assessment and a robust concussion assessment battery at pre-injury baseline, day 2, day 4, asymptomatic, and unrestricted medical clearance. Naturalistic driving (measured with in-car global positioning systems) will be captured from day 2 to day 9 (7 days total). This study will determine the acute and subacute time course of post-concussion driving impairment and determine key predictors of post-concussion driving performance. Results from this innovative approach will have a broad and positive impact that will improve the safety of both concussed individuals and the general population, guide the practices of health professionals, inform the future work of researchers, and substantiate the work of policy-makers by providing evidence-based recommendations for managing post- concussion driving.