Key points Is the first episode of syncope associated with an increased risk of subsequent motor vehicle accidents? Findings This population-based retrospective observational cohort study examined 9,223 patients who visited the emergency department (ED) for a first episode of syncope and 34,366 matched control patients who visited the ED for a condition other than syncope. The researchers found that the risk of a car accident over the next year was similar in both groups. Meaning In contrast to the results of previous studies, these findings suggest that stricter driving restrictions may not be necessary after syncope. |
Importance
Medical driving restrictions are burdensome, but recurrence of syncope while driving can lead to a motor vehicle accident (MVC). Few empirical data inform current driving restrictions after syncope.
Aim
To examine the risk of MVC among patients visiting the emergency department (ED) after the first episode of syncope.
Design, scope and participants
A population-based retrospective observational cohort study was conducted on the risk of MVC after the first episode of syncope in British Columbia, Canada. Patients who visited any of the 6 urban EDs for syncope and collapse were matched by age and sex to 4 control patients who visited the same ED in the same month for a condition other than syncope.
Patients’ ED medical records were linked to administrative health records, driving history, and detailed accident reports. Accident-free survival among people with syncope was then compared with that of matched control patients. Data analyzes were conducted from May 2020 to March 2022.
Exhibitions
Initial visit to the emergency department for syncope.
Main results and measures
Participation as a driver in an MVC in the year following the index ED visit. Accidents were identified using data from insurance claims and police accident reports.
Results
The study cohort included 43,589 patients (9,223 patients with syncope and 34,366 controls; median [IQR] age, 54 [35-72] years; 22,360 [51.3%] women; 5,033 [11.5%] ] rural residents).
At baseline, crude MVC incidence rates among the syncope and control groups were higher than among the general population (12.2, 13.2, and 8.2 accidents per 100 driver-years, respectively).
In the year following the index ED visit, 846 first accidents occurred in the syncope group and 3457 first accidents in the control group, indicating that there was no significant difference in the risk of subsequent MVC (9.2% vs. to 10.1%; adjusted hazard ratio [aHR], 0.93; 95% CI, 0.87-1.01, P = .07).
The risk of subsequent accidents among patients with syncope was not significantly increased in the first 30 days after the index ED visit (aHR, 1.07; 95% CI, 0.84-1.36; P = 0 .56) or among subgroups at increased risk of adverse events after syncope (e.g., age >65 years, cardiogenic syncope, Canadian syncope risk score ≥1).
Conclusions and relevance The findings of this population-based retrospective cohort study suggest that patients who visit the ED with a first episode of syncope have a risk of subsequent accident similar to that of the average ED patient. Tighter driving restrictions may not be warranted after syncope. |
