Background: Driving is a privilege which carries significant emotional and social value to patients, enabling increased independence. After ischemic stroke, residual deficits may prevent patients from driving. We aimed to identify factors predictive of return to driving after stroke.
Methods: We abstracted data from our ischemic stroke database and included all patients with ischemic stroke from April 1st, 2016 to March 31st 2017 who were reported to have been driving prior to their stroke. Formal driving evaluations were performed, if deemed necessary by the treating physician. Follow-up information was obtained at 90 days and included whether patients had returned to driving. Patients were divided into two groups - those who returned to driving at 90 days vs. not driving at 90 days. We compared baseline demographics including age, vascular risk factors, NIHSS score, acute stroke treatment (mechanical thrombectomy and IV thrombolysis), stroke subtype determined based on ESUS criteria, and hospital acquired-infections, hospital readmission rate.
Results: We identified 282 patients with ischemic stroke who were driving prior to their stroke; 149 patients (52.8%) returned to driving at 90 days. On univariate analyses, patients who returned to driving were more likely to be younger (62.5 ± 15.1 years vs 70.6 ± 13.5 years; p <0.001), have a lower admission NIHSS score (3 vs 7; p<0.001) and 24-hour NIHSS (1 vs 5; p<0.001), less likely to have diabetes (22.9% vs 36.1%; p 0.016), coronary artery disease (11.9% vs 21.7%; p 0.03), large vessel occlusion (36.1% vs 51.5%; p 0.022), and hospital-acquired infections (3.6% vs 13.9%; p 0.004). On regression models, only age (adjusted OR 0.97; 95% CI 0.94-0.99, p 0.014) and NIHSS at 24 hours (adjusted OR 0.79; 95% CI 0.7-0.89; p <0.001) were predictive of ability to return to driving at 90 days. Among NIHSS items, absence of motor arm and language deficits predicted ability to drive at 90 days.
Conclusion: In patients with ischemic stroke, younger age and lower 24-hour NIHSS predict return to driving after ischemic stroke. Larger studies are needed to confirm our findings.