Faculty Collaboration Database

Patients with minimal hepatic encephalopathy have poor insight into their driving skills. Clin Gastroenterol Hepatol 2008 Oct;6(10):1135-9; quiz 1065

Date

10/22/2008

Pubmed ID

18928938

DOI

10.1016/j.cgh.2008.05.025

Scopus ID

2-s2.0-52949094627 (requires institutional sign-in at Scopus site)   64 Citations

Abstract

BACKGROUND & AIMS: Minimal hepatic encephalopathy (MHE) is associated with impaired driving skills. It is not clear whether patients have insight into this. The Driving Behavior Survey (DBS) is a validated self- or observer-administered questionnaire. DBS consists of a total score (maximum, 104) and an attention-related driving skills section (maximum, 40). DBS was used to compare self-assessment with observer-assessment of driving skills in cirrhotic patients tested for MHE.

METHODS: Forty-seven nonalcoholic cirrhotic patients and 40 controls underwent psychometric tests, DBS, and driving simulation with navigation/driving tasks. An adult familiar with the subject's driving completed the DBS independently. Simulator performances, total DBS scores, and driving skill scores were compared between/within groups (MHE+, MHE-, and controls) with respect to self-assessment and observer assessment.

RESULTS: Thirty-six patients were MHE+ and 11 were MHE-. MHE+ had a significantly higher simulator crash (MHE+, 3; MHE-, 1.2; controls, 1.7; P = .001) and illegal turn rate (MHE+, 1.2; MHE-, 0.3; controls, 0.1; P = .0001). Despite this worse performance, MHE+ patients rated themselves similar to MHE- patients and control groups on total (P = .28) and driving skills scores (P = .19). Observer assessment in MHE+ was significantly lower for total (P = .0001) and driving skills (P = .0001) compared with observer assessment for MHE- patients and control groups. MHE+ patients were rated significantly lower on driving skills (34 vs 37; P = .02) and trended lower in the total score (P = .08) by observers compared with self-ratings. In contrast, MHE- and control groups rated themselves similar to their observers on driving skills and total DBS scores.

CONCLUSIONS: MHE patients have poor insight into their driving skills. A part of the MHE patient's clinical interview should be to increase awareness of this driving impairment.

Author List

Bajaj JS, Saeian K, Hafeezullah M, Hoffmann RG, Hammeke TA

Author

Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Automobile Driver Examination
Automobile Driving
Female
Hepatic Encephalopathy
Humans
Liver Cirrhosis
Male
Middle Aged
Self-Assessment
Surveys and Questionnaires