1. There was no significant difference in risk of motor vehicle accidents between patients with an emergency department presentation with syncope compared to matched controls.

Evidence Rating Level: 2 (Good)

Syncope, defined as a sudden loss of consciousness and postural tone, can incapacitate drivers and result in motor vehicle accidents. While some literature believes that syncope-related accidents are rare and driving restrictions following syncopal episodes are not warranted, others believe that more restrictions are required. As there is not yet a consensus on this controversial topic, this study aims to identify crash risk following emergency department presentation with a syncopal episode. In this retrospective cohort study, 9223 participants with visits to the emergency department in British Columbia, Canada for a syncopal episode and 34,366 matched controls were assessed for motor vehicle accidents following the hospital visit. The results show that there was no significant difference with regards to risk in motor vehicle accident between the syncope and control groups; 9.2% of patients experienced a crash in the syncope group versus 10.1% in the control group (aHR 0.93, 95%CI 0.87-1.01). In conclusion, no evidence of increased crash risk following a syncopal episode was identified, which may suggest that current driving restrictions and guidelines following a first-episode syncope are already well delineated. However, there are several factors that must be taken into consideration prior to interpreting these results. For instance, individuals may be more reluctant to drive and may be informed by their physicians to avoid driving following the syncopal incident, which can naturally reduce motor vehicle crash risk. Additionally, while this study utilized a straight-forward design and obtained objective data to assess accident risk, it still has limitations. Firstly, this study did not discern specific causes for syncopal episodes in these patients and varying etiologies may have different risks of syncope recurrence. Moreover, the participants’ pre-existing comfort and experience with driving were not identified. This study’s generalizability is also limited as participants were only recruited from British Columbia. Nevertheless, given the controversy surrounding driving regulations and syncopal episodes, these findings do warrant further research and investigation.

Click to read the study in JAMA Internal Medicine

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