Background Among individuals with recent syncope, recurrence of syncope while driving might incapacitate a driver and cause a motor vehicle crash. Current driving restrictions assume that some forms of syncope transiently increase crash risk. We evaluated whether syncope is associated with a transient increase in crash risk. Methods We performed a case-crossover analysis of linked administrative health and driving data from British Columbia, Canada (2010 to 2015). We included licensed drivers who visited an emergency department with "syncope and collapse" and who were involved as a driver in an eligible motor vehicle crash, both within the study interval. Using conditional logistic regression, we compared the rate of emergency visits for syncope in the 28 days before crash (the "pre-crash interval") with the rate of emergency visits for syncope in 3 self-matched 28-day control intervals (ending 6, 12, and 18 months before the crash). Results Among eligible crash-involved drivers, 47 of 3026 pre-crash intervals and 112 of 9078 control intervals had emergency visits for syncope, indicating syncope was not significantly associated with subsequent crash (1.6% vs 1.2%; adjusted odds ratio [OR], 1.27; 95% confidence interval [CI], 0.90-1.79; P = 0.18). There was no significant association between syncope and crash in subgroups at higher risk for adverse outcomes after syncope (eg, age > 65 years, cardiovascular disease, cardiac syncope). Conclusions In the context of prevailing modifications of driving behaviour after syncope, an emergency department visit for syncope did not transiently increase the risk of subsequent traffic collision. Overall crash risks after syncope appear to be adequately addressed by current driving restrictions.

Background: Physicians are often asked to counsel patients about driving safety after syncope, yet little empirical data guides such advice. Methods: We identified a population-based retrospective cohort of 9,507 individuals with a driver license who were discharged from any of six urban emergency departments (EDs) with a diagnosis of 'syncope and collapse'. We examined all police-reported crashes that involved a cohort member as a driver and occurred between 1 January 2010 and 31 December 2016. We categorized crash-involved drivers as 'responsible' or 'non-responsible' for their crash using detailed police-reported crash data and a validated responsibility scoring tool. We then used logistic regression to test the hypothesis that recent syncope was associated with driver responsibility for crash. Results: Over the 7-year study interval, cohort members were involved in 475 police-reported crashes: 210 drivers were deemed responsible and 133 drivers were deemed non-responsible for their crash; the 132 drivers deemed to have indeterminate responsibility were excluded from further analysis. An ED visit for syncope occurred in the three months leading up to crash in 11 crash-responsible drivers and in 5 crash-non-responsible drivers, suggesting that recent syncope was not associated with driver responsibility for crash (adjusted odds ratio, 1.31; 95%CI, 0.40-4.74; p=0.67). However, all drivers with cardiac syncope were deemed responsible, precluding calculation of an odds ratio for this important subgroup. Conclusions: Recent syncope was not significantly associated with driver responsibility for traffic crash. Clinicians and policymakers should consider these results when making fitness-to-drive recommendations after syncope.

Study objective Syncope that occurs while driving can result in a motor vehicle crash. Whether individuals with a prior syncope-related crash exhibit an exceptional risk of subsequent crash remains uncertain. Methods We performed a population-based retrospective observational study of patients diagnosed with ‘syncope and collapse' at any of 6 emergency departments in British Columbia, Canada (2010 to 2015). Data were obtained from chart abstraction, administrative health records, insurance claims and police crash reports. We compared crash-free survival among individuals with crash-associated syncope (a crash and an emergency visit for syncope on the same date) to that among controls with syncope alone (no crash on date of emergency visit for syncope). Results In the year following their index emergency visit, 13 of 63 drivers with crash-associated syncope and 852 of 9,160 controls with syncope alone experienced a subsequent crash as a driver (crash risk 21% versus 9%). After accounting for censoring and potential confounders, crash-associated syncope was not associated with a significant increase in the risk of subsequent crash (adjusted hazard ratio [aHR] 1.38, 95% confidence interval [CI] 0.78 to 2.47). Individuals with crash-associated syncope were 31-fold more likely to have physician driving advice documented during their index visit (prevalence ratio 31.0, 95% CI, 21.3 to 45.1). In the subgroup without documented driving advice, crash-associated syncope was associated with a significant increase in subsequent crash risk (aHR 1.88, 95% CI 1.06 to 3.36). Conclusions Crash risk after crash-associated syncope appears similar to crash risk after syncope alone.

Importance Medical driving restrictions are burdensome, yet syncope recurrence while driving can cause a motor vehicle crash (MVC). Few empirical data inform current driving restrictions after syncope. Objective To examine MVC risk among patients visiting the emergency department (ED) after first-episode syncope. Design, Setting, and Participants A population-based, retrospective observational cohort study of MVC risk after first-episode syncope was performed in British Columbia, Canada. Patients visiting any of 6 urban EDs for syncope and collapse were age- and sex-matched to 4 control patients visiting the same ED in the same month for a condition other than syncope. Patients' ED medical records were linked to administrative health records, driving history, and detailed crash reports. Crash-free survival among individuals with syncope was then compared with that among matched control patients. Data analyses were performed from May 2020 to March 2022. Exposures Initial ED visit for syncope. Main Outcomes and Measures Involvement as a driver in an MVC in the year following the index ED visit. Crashes were identified using insurance claim data and police crash reports. Results The study cohort included 43 589 patients (9223 patients with syncope and 34 366 controls; median [IQR] age, 54 [35-72] years; 22 360 [51.3%] women; 5033 [11.5%] rural residents). At baseline, crude MVC incidence rates among both the syncope and control groups were higher than among the general population (12.2, 13.2, and 8.2 crashes per 100 driver-years, respectively). In the year following index ED visit, 846 first crashes occurred in the syncope group and 3457 first crashes occurred in the control group, indicating no significant difference in subsequent MVC risk (9.2% vs 10.1%; adjusted hazard ratio [aHR], 0.93; 95% CI, 0.87-1.01; P = .07). Subsequent crash risk among patients with syncope was not significantly increased in the first 30 days after index ED visit (aHR, 1.07; 95% CI, 0.84-1.36; P = .56) or among subgroups at higher risk of adverse events after syncope (eg, age >65 years; cardiogenic syncope; Canadian Syncope Risk Score ≥1). Conclusions and Relevance The findings of this population-based retrospective cohort study suggest that patients visiting the ED with first-episode syncope exhibit a subsequent crash risk no different than the average ED patient. More stringent driving restrictions after syncope may not be warranted.

differences in ED diagnoses was determined by the adjusted F, a variant of the second-order Rao-Scott adjusted χ 2 statistic. 5sults | Among the total population of 8 080 738 participants, 51.5% were boys, 76.0% were white, and 24.0% were Hispanic.Across all ED diagnoses, boys and girls did not have statistically significant differences in prevalence rates (Table ).Across all ED diagnoses, the overall prevalence rate was 1.4% (95% CI, 1.0%-1.8%).The prevalence of any OSFED diagnosis was 0.7% (95% CI, 0.5%-1.0%).The prevalence of AN was 0.1% (95% CI, 0.0%-0.3%).No cases of BN were present in this sample.Finally, the prevalence of BED was 0.6% (95% CI, 0.4%-0.9%).Discussion | Significant sex differences were not found across ED diagnoses.Similarly, past research with adolescents aged 13 to 18 years did not find sex differences in the prevalence of AN; however, differences emerged for BN, BED, and subthreshold AN, with higher prevalence among girls. 6Taken together, sex differences in EDs may not emerge until adolescence.This is consistent with previous research demonstrating a lack of prepubertal sex differences in EDs, with elevated prevalence of EDs in girls during and after puberty. 7 Limitations of the study include the exclusion of OSFED AN, which the KSADS operationally defined only by caregivers' report of emaciation, and no assessment of avoidant and restrictive food intake disorder.Although EDs are not the focus of the ABCD study, use of the KSADS as opposed to a diagnostic tool tailored to EDs is also a limitation.The low prevalence of EDs may have reduced statistical power to detect sex differences.Future researchers may wish to characterize this sample in greater detail, including assessment of race/ethnicity, body mass index, and psychiatric comorbidity.As the ABCD cohort releases additional waves of data, researchers are encouraged to harness this nationally representative, prospective data set to explore developmental risk factors for EDs.