Driving after Concussion: Symptom Clusters and Neurocognition Uniquely Relate to Post-concussion Driving Performance.

Purpose: This study aimed to identify clinical concussion assessment outcomes that uniquely capture simulated driving performance among acutely concussed individuals, relative to controls.

Methods: Cross-sectional design. Twenty-eight college students within 72 hours of concussion and 46 non-concussed controls participated in the study. We collected the following clinical concussion assessment outcomes: four concussion symptom clusters, seven computerized neurocognitive domain scores, Standardized Assessment of Concussion total score, Balance Error Scoring System total score, and tandem gait completion time. The following simulated driving outcomes were included (count): total collisions, speed exceedances, centerline crossings, and road edge excursions. We used separate generalized linear mixed regression models fit using a Poisson distribution with group, assessment, and interaction effects.

Results: Higher migrainous symptoms ( P < 0.001), cognitive-fatigue symptoms ( P = 0.041), poorer visual memory ( P = 0.015), and slower reaction time ( P = 0.023) in concussion group were associated with higher risk of committing speed exceedances, relative to controls. Conversely, better performance on the continuous performance test ( P = 0.046) and Standardized Assessment of Concussion ( P = 0.045) in concussion group was associated with higher risk of committing speed exceedances relative to controls. Poorer performance on psychomotor speed ( P = 0.001), reaction time ( P = 0.031), cognitive flexibility ( P = 0.004), and executive function ( P = 0.003) was associated with higher risk of committing centerline crossings in concussion group, relative to controls. Conversely, better performance on the continuous performance test ( P = 0.035) and higher affective symptoms ( P = 0.013) were associated with higher risk of committing centerline crossings and road edge excursions, respectively, relative to controls.

Conclusions: Our results highlight key symptom clusters and computerized neurocognitive outcomes that uniquely inform poorer simulated driving performance in acutely concussed individuals. Symptom clusters and computerized neurocognitive function might be helpful when discussing with patients about return to driving decisions post-concussion.