title: Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test.
abstract: Patients with minimal hepatic encephalopathy (MHE) have impaired driving skills, but association of MHE with motor vehicle crashes is unclear. Standard psychometric tests (SPT) or inhibitory control test (ICT) can be used to diagnose MHE. The aim was to determine the association of MHE with crashes and traffic violations over the preceding year and on 1-year follow-up. Patients with cirrhosis were diagnosed with MHE by ICT (MHEICT) and SPT (MHESPT). Self and department-of-transportation (DOT)-reports were used to determine crashes and violations over the preceding year. Agreement between self and DOT-reports was analyzed. Patients then underwent 1-year follow-up for crash/violation occurrence. Crashes in those with/without MHEICT and MHESPT were compared. 167 patients with cirrhosis had DOT-reports, of which 120 also had self-reports. A significantly higher proportion of MHEICT patients with cirrhosis experienced crashes in the preceding year compared to those without MHE by self-report (17% vs 0.0%, P = 0.0004) and DOT-reports (17% vs 3%, P = 0.004, relative risk: 5.77). SPT did not differentiate between those with/without crashes. A significantly higher proportion of patients with crashes had MHEICT compared to MHESPT, both self-reported (100% vs 50%, P = 0.03) and DOT-reported (89% vs 44%, P = 0.01). There was excellent agreement between self and DOT-reports for crashes and violations (Kappa 0.90 and 0.80). 109 patients were followed prospectively. MHEICT patients had a significantly higher future crashes/violations compared to those without (22% vs 7%, P = 0.03) but MHESPT did not. MHEICT (Odds ratio: 4.51) and prior year crash/violation (Odds ratio: 2.96) were significantly associated with future crash/violation occurrence.
  
  
  CONCLUSIONS
  Patients with cirrhosis and MHEICT have a significantly higher crash rate over the preceding year and on prospective follow-up compared to patients without MHE. ICT, but not SPT performance is significantly associated with prior and future crashes and violations. There was an excellent agreement between self- and DOT-reports.
authors: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA 23221, USA. jasmohan.bajaj@va.gov
authors: Jasmohan S
authors: JS
authors: Bajaj
authors: Kia
authors: K
authors: Saeian
authors: Christine M
authors: CM
authors: Schubert
authors: Muhammad
authors: M
authors: Hafeezullah
authors: Jose
authors: J
authors: Franco
authors: Rajiv R
authors: RR
authors: Varma
authors: Douglas P
authors: DP
authors: Gibson
authors: Raymond G
authors: RG
authors: Hoffmann
authors: R Todd
authors: RT
authors: Stravitz
authors: Douglas M
authors: DM
authors: Heuman
authors: Richard K
authors: RK
authors: Sterling
authors: Mitchell
authors: M
authors: Shiffman
authors: Allyne
authors: A
authors: Topaz
authors: Sherry
authors: S
authors: Boyett
authors: Debulon
authors: D
authors: Bell
authors: Arun J
authors: AJ
authors: Sanyal
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology*; D000328:Adult; D001334:Automobile Driving / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011594:Psychometrics; D011596:Psychomotor Disorders / Q000523:psychology; D012650:Self Disclosure