Commercial drivers should stay off the road for a year after TIA or stroke

College Fellows elected to Institute of MedicineNew ACP EVP/CEO speaks to members via the Web

Patients who have had a transient ischemic attack (TIA) or stroke should not drive a commercial vehicle for at least the next year, determined a panel of experts advising the U.S. Department of Transportation.

The three-member panel conducted a systematic review on stroke and TIA survivors' risk for recurrent attacks and motor vehicle crashes. They found strong evidence that people who have had a TIA are at increased risk for stroke. Specifically, their pooled analysis found a 65-fold increased risk for stroke one month after TIA, which decreased to 16-fold at six months, and 6-fold at one year. Less evidence was available regarding the motor vehicle crash risk of stroke survivors. Because the studies on this topic were small and of low-to-moderate quality, the experts concluded that the current evidence only suggests that drivers who had a stroke are at increased, but unspecified, risk for a crash.

There is moderate evidence to suggest that neuropsychological testing can predict poststroke patients' driving performance, the experts concluded. In particular, the dot cancellation test, road sign recognition test and “what else is in the square” test were found to be significant outcome predictors in multiple studies.

Based on their review of the evidence, the panel concluded that patients who have suffered a TIA or minor stroke should not drive a commercial vehicle for at least one year, even if they are taking medication to prevent a stroke. After a year, individuals who want to drive commercially should undergo a thorough physical and mental evaluation by a neurologist or other physician knowledgeable on the topic.

The evaluation process should include an on-road driving evaluation, because it remains the gold standard for certification, the experts said. If the drivers pass the examination, they should be recertified on annual basis and any recurrence of stroke or TIA will result in permanent disqualification. The panel's conclusions were published by Stroke on Oct. 28.