Study Suggests Syncope Does Not Pose Greater Road Risk

Sarasota, FL (WorkersCompensation.com) – The American Heart Association defines syncope as a temporary loss of consciousness usually related to insufficient blood flow to the brain. Also known as fainting or passing out, syncope can be triggered by several causes including heat stress, dehydration, exhaustion, and blood pressure. Additionally, serious heart conditions such as abnormal heart rate or obstruction of blood flow can cause syncope. Syncope can also be caused by seizure activity.

Syncope may or may not be considered a safety risk, depending on the person’s job, the cause and the frequency. While you can’t always control if someone has a syncopal episode, you can implement safety precautions such as fall protection equipment and similar measures.

When it comes to driving however, syncope episodes are more concerning as having an episode incapacitates a driver and ultimately can cause a motor vehicle crash. However, studies of whether the risk of accidents is greater in patients that have a history of syncope have vastly different results.

For instance, in one Danish 2016 study the researchers found that patients with a history of syncope were 83 percent more likely to have a vehicle accident. The five-year risk of those with a syncope history was 8.2 percent compared to 5.1 percent for the general population. Yet in another study occurring from 1998 to 2011, the level of motor vehicle accidents was much lower. The researchers concluded that the risk of serious harm or death due to a vehicle accident was less than .0035 percent in those patients that had a history of syncope. In fact, they concluded that the risk of car accidents for syncope patients was less than the general public. 

Given the opposition of results of past studies, and based on the fact that driving restrictions impair quality of life and affect employment, researchers from the University of British Columbia in Vancouver set out to determine whether a first episode of syncope was associated with an increased risk of a subsequent motor vehicle accident.

Patients that had received treatment at one of six emergency departments between January 1, 2010, and December 31, 2015 for syncope and collapse were tracked and categorized, with comorbidities noted. The patient’s records were then cross-referenced with administrative health records, driving history, and detailed crash reports, with the analysis occurring from May 2020 to March of this year.

Ninety-two percent held an active driver’s license, and 26 percent had experienced a vehicle accident in the years prior to the study. Compared to the control group, patients with syncope had fewer doctor’s visits in the year prior to the index visit. Researchers also noted that they were more likely to have blood pressure and certain heart medications, as well as diuretics. However, they also less likely to have recent prescriptions for opioids, antipsychotics, and tranquilizers. Additionally, they were also less likely to have prior traffic violations.

The researchers found that in most cases, patients were listed as a “definite or likely” case of a syncopal episode. Additionally, most causes listed were from hypotension or from a vagal nerve stress response. It was also noted that [hysicians had given driving advice in only 1.4 percent of the syncope group.

In the syncope group, 9.2 percent experienced crashes within the first year, compared to 10.1 percent for the control group. The death rate in the syncope group was 1.3 percent, compared to 2.6 percent for the control group. Additionally the rate of hospitalization in the syncope group was 1.0 percent, compared to 1.4 percent in the control group.

Those patients that were noted to have had a “definite or likely” syncope episode had a significantly lower likelihood of a subsequent crash compared to the control group. Additionally those drivers with a commercial license were no more likely to experience crashes than those in the control group.

The researchers acknowledged some of the limitations of the study. For instance, syncope was identified through standard diagnostic coding and did not include those cases where another condition may have cause syncope. Additionally, while participants held a driver’s license, individual road exposure data was not included or taken into account for both groups.

Overall, the researchers concluded that individuals with first-episode syncope treated through usual clinical practice were no greater a threat than the average emergency department patient.

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