Characteristics of motor vehicle crashes associated with seizure: Car crash semiology

Andrew Neal; Ross Carne; Morris Odell; David Ballek; Wendyl J D'Souza; Mark J Cook

doi:10.1212/WNL.0000000000006208

Characteristics of motor vehicle crashes associated with seizure: Car crash semiology

Neurology. 2018 Sep 18;91(12):e1102-e1111. doi: 10.1212/WNL.0000000000006208. Epub 2018 Aug 22.

Authors

Andrew Neal¹, Ross Carne², Morris Odell², David Ballek², Wendyl J D'Souza², Mark J Cook²

Affiliations

¹ From the Departments of Neurology (A.N., R.C., W.J.D., M.J.C.) and Medicine (W.J.D., M.J.C.), St Vincent's Hospital Melbourne; Department of Medicine, Royal Melbourne Hospital (A.N.), and Graeme Clark Institute (M.J.C.), University of Melbourne; Faculty of Health (R.C.), Deakin University; Victorian Institute of Forensic Medicine, Department of Forensic Medicine (M.O.), Monash University; and Corporate Strategy and Operational Improvement Department (D.B.), Victoria Police, Melbourne, Australia. andrew.neal@unimelb.edu.au.
² From the Departments of Neurology (A.N., R.C., W.J.D., M.J.C.) and Medicine (W.J.D., M.J.C.), St Vincent's Hospital Melbourne; Department of Medicine, Royal Melbourne Hospital (A.N.), and Graeme Clark Institute (M.J.C.), University of Melbourne; Faculty of Health (R.C.), Deakin University; Victorian Institute of Forensic Medicine, Department of Forensic Medicine (M.O.), Monash University; and Corporate Strategy and Operational Improvement Department (D.B.), Victoria Police, Melbourne, Australia.

PMID: 30135255
DOI: 10.1212/WNL.0000000000006208

Abstract

Objective: To examine the characteristics of seizure-related vehicle crashes (SRC).

Method: Using a nested case-control design, we identified and compared cases of SRC involving confirmed epilepsy patients with 137,126 non-seizure-related crash controls (NSRC) in the Australian state of Victoria. SRC were identified from approximately 20,000 epileptologist medical records by cross-referencing this source with the Victorian Police Traffic Incident database and the Road Crash Information System Database (RCISD).

Results: Seventy-one SRC involving 62 patients with epilepsy were identified. Thirty-seven SRC resulted in injury and could be identified in the RCISD and compared to NSRC. Seizure-related crashes typically involved a single vehicle (57% vs 29%, p < 0.001) carrying a sole occupant (95% vs 48%, p = 0.001). Most SRC began with an "out of control movement" (51% vs 10%, p < 0.001) and the subsequent collision type differed significantly between the groups (p < 0.001). The majority of SRC were a "collision with a fixed object" (54% vs 17%, p < 0.001) involving an "off path on straight" mechanism (48% vs 10%, p < 0.001). Regarding all 71 SRC, generalized as compared with focal epilepsy crashes involved younger drivers (p < 0.001), seizure-provoking factors (p = 0.033), and occurred earlier in the day (p = 0.004).

Conclusions: Given the distinct SRC features, we propose that clinicians, crash investigators, and driver licensing authorities incorporate collision characteristics into the overall assessment of suspected SRC. Further research should examine restricting driving immediately after risk periods as a harm-minimization strategy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Accidents, Traffic / statistics & numerical data*
Adult
Age Factors
Case-Control Studies
Databases, Factual
Female
Humans
Male
Seizures / diagnosis
Seizures / epidemiology*
Time Factors
Victoria / epidemiology
Young Adult