脳損傷者の運転再開可否判断時期についての後方視的検討

A Retrospective Study to Determine the Timing of Driving Resumption in Patients with Brain Injury

要旨

はじめに：これまでわれわれは多くの脳損傷患者に対し，病状，身体所見，高次脳機能検査，ドライビングシミュレーターなどの評価結果から自動車運転再開の可否判断を行ってきた．今回，運転再開可否を判断した時期と運転困難と判断した理由について，後方視的に検討したので報告する．

対象：2014年4月1日〜2020年3月31日に当院に入院中あるいは外来にて運転再開評価を行った脳損傷患者279人を対象とした．

方法：診療録より後方視的に運転再開時期，運転再開不可となった理由，外来訓練回数などについて調査し検討を行った．

結果：233人に運転再開が許可され，46人は許可されなかった．当院入院中に運転が許可されたのは65人，当院退院後外来通院中に許可されたのは83人，他院より運転再開目的に外来紹介された85人であった．当院退院後外来通院中に運転再開が許可された患者のうち，94％の患者が退院後2年以内に許可されていた．許可されなかった患者の判断時期は，当院入院中6人，当院退院後外来通院17人，他院からの紹介23人であった．運転が許可されなかった理由は，高次脳機能障害が39人，同名半盲を含む眼科的問題が5人，てんかん発作が2人であった．

結論：脳損傷者の運転再開支援は，回復期リハビリテーション病棟入院中のみで完結するものではなく，外来リハビリテーション医療の継続的提供が重要である．

Abstract

Introduction：In this study, we conducted a retrospective investigation to determine when patients with brain damage could be tested and permitted to resume driving and also assessed reasons for disallowance. Subjects：A total of 279 patients with brain damage were included in the study. These patients underwent an assessment for driving resumption between April 1, 2014 and March 31, 2020, either as in-patient in our hospital or attending as an outpatient. Method：Medical records were examined to ascertain details regarding timing of driving resumption, reason for disallowance, and number of outpatient training sessions. Results：Among the study participants, 233 patients were permitted to resume driving and 46 were not. Among permitted patients, 65 were hospitalized in our hospital at that time, 83 had been discharged from our hospital and were attending as outpatients, and 85 had been referred to our outpatient clinic from other hospitals. Among patients not permitted to drive, 6 were hospitalized in our hospital at the time, 17 had been discharged from our hospital and were attending as outpatients, and 23 had been referred from other hospitals. Conclusions：Evidence supporting driving resumption in patients who were brain damaged could not be determined while being hospitalized in convalescent rehabilitation wards. Hence, continued provision of outpatient rehabilitation therapy is important.