title: The 4Cs (crash history, family concerns, clinical condition, and cognitive functions): a screening tool for the evaluation of the at-risk driver.
abstract: OBJECTIVE
  To evaluate the effectiveness of crash history, family concerns, clinical condition, and cognitive function (the 4Cs, an interview-based screening tool for health providers working with older drivers) in identifying at-risk older drivers.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Clinical driving evaluation program at a teaching hospital in the United States.
  
  
  METHODS
  One hundred sixty patients who completed comprehensive driving evaluations between 2003 and 2009.
  
  
  METHODS
  Medical record information was used to identify component and total 4Cs scores. Other measurements included the Trail Making Test, the Mini-Mental State Examination, and brake reaction time. The outcome variable was performance on a 45-minute road test.
  
  
  RESULTS
  Fifty participants passed the road test, 67 failed, and 43 demonstrated marginal driving skills. The relationship between 4Cs scores and road test outcome was statistically significant (P<.001). The domains most strongly associated with road test outcome were cognitive function (P<.001) and family concerns (P=.01). Scores of 9 or greater-on the 4Cs identified 84% of participants who were at risk for poor road test performance.
  
  
  CONCLUSIONS
  The 4Cs, an interview based screening tool, may be a useful marker to identify at-risk older drivers.
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. moconnor@bidmc.harvard.edu
authors.forename: Margaret G
authors.initials: MG
authors.lastname: O'Connor
authors.forename: Lissa R
authors.initials: LR
authors.lastname: Kapust
authors.forename: Bixuan
authors.initials: B
authors.lastname: Lin
authors.forename: Ann M
authors.initials: AM
authors.lastname: Hollis
authors.forename: Richard N
authors.initials: RN
authors.lastname: Jones
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D001333:Automobile Driver Examination / Q000706:statistics & numerical data*; D001334:Automobile Driving / Q000523:psychology*; D003071:Cognition; D005190:Family / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009483:Neuropsychological Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment