title: Bias in counseling of seizure patients following a transient impairment of consciousness: differential adherence to driver fitness guidelines.
abstract: OBJECTIVE
  To determine primary care physicians' counseling as well as patients' driving behaviors following seizure and non-seizure events impairing consciousness in the community.
  
  
  METHODS
  Patients attending a rapid-referral first seizure clinic were entered into the study if they were deemed medically-unfit to drive according to national guidelines for driving licensure: had experienced a seizure or an unexplained episode of lost consciousness, and had a valid driver's license at the time of their index event. Risk of physician counseling in the community regarding driving cessation in the interval between initial primary care assessment and neurological consultation was examined as a primary outcome, and patient driving cessation was examined as a secondary outcome.
  
  
  RESULTS
  106 of 192 (55%) patients attending clinic met guideline criteria requiring driver fitness counseling in the primary care community, and 89 patients (46%) were deemed medically-unfit to drive following the initial specialist consultation appointment. Among medically unfit driver cases, 73% were ultimately deemed to have experienced a seizure and 27% had experienced a non-seizure event (e.g. syncope, PNES). Driver fitness counseling was more likely for seizure than non-seizure cases (unadjusted odds ratio: 4.14, p<0.05), as was patient driving cessation (5.10, p<0.05).
  
  
  CONCLUSIONS
  Physician compliance with clinical practice guidelines appears strongly biased when counseling about driving following an episode of transient impairment in consciousness. The failure of the primary care medical community to apply driver fitness counseling equitably to both seizure and non-seizure drivers may have ramifications upon public safety or conversely disease-related quality-of-life.
authors.affiliation: Department of Medicine, Division of Neurology, University of Alberta, 2E3-31 WMC, 8440-112 St, Edmonton, Canada T6G 2B7. Electronic address: jeff.jirsch@ualberta.ca.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jirsch
authors.affiliation: Department of Medicine, Division of Neurology, University of Alberta, 2E3-31 WMC, 8440-112 St, Edmonton, Canada T6G 2B7. Electronic address: msiddiqi@ualberta.ca.
authors.forename: Maria
authors.initials: M
authors.lastname: Siddiqi
authors.affiliation: Department of Medicine, Division of Neurology, University of Alberta, 2E3-31 WMC, 8440-112 St, Edmonton, Canada T6G 2B7. Electronic address: smyth@ualberta.ca.
authors.forename: Penelope
authors.initials: P
authors.lastname: Smyth
authors.affiliation: School of Public Health, University of Alberta, 11405-87 Ave, Edmonton, Canada T6G 1C9. Electronic address: katerina.maximova@ualberta.ca.
authors.forename: Katerina
authors.initials: K
authors.lastname: Maximova
mesh_terms: D000063:Accidents, Traffic / Q000331:legislation & jurisprudence / Q000517:prevention & control; D000328:Adult; D000416:Alberta; D001334:Automobile Driving / Q000331:legislation & jurisprudence; D003376:Counseling / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008004:Licensure; D008297:Male; D010349:Patient Compliance; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians'; D012640:Seizures; D014474:Unconsciousness
keywords: Driving cessation; Driving safety; Epilepsy; Practice Guidelines; Seizure; Syncope