Citation

Inamasu J, Nakatsukasa M, Nakae S. Acute Med. Surg. 2021; 8(1): e682.

Copyright

(Copyright © 2021, Japanese Association for Acute Medicine, Publisher John Wiley and Sons)

DOI

10.1002/ams2.682

PMID

34277013

Abstract

Several human activities such as defecation are known to trigger aneurysmal subarachnoid hemorrhage (aSAH).1 While car drivers may experience stress-induced blood pressure elevation as high as 20 mmHg,2 there has been no scientific evidence that driving triggers aSAH. Nevertheless, information on the clinical picture of aSAH occurring while driving may be useful to emergency medicine physicians/emergency medical services (EMSs), considering that drivers who experience aSAH may cause road traffic accidents (RTAs) and injury to themselves or others on the road. The behavioral response of SAH-afflicted drivers, that is, how frequently they can avoid RTAs by pulling over, has not been reported in the literature, either. Furthermore, it may be interesting to investigate how aSAH-afflicted drivers present to medical institutions. Following approval by our Institutional Ethics Committee, we conducted a single-center retrospective observational study to document the behavioral responses and mode of emergency department (ED) arrival of patients who sustained aSAH while driving. We used a data set of 623 patients with aSAH (218 men/405 women; mean age, 63.9 ± 14.8 years) admitted to our ED between January 2008 and December 2020. Among them, 16 patients (6 men/10 women; mean age, 53.7 ± 11.0 years) had sustained an aSAH while driving, with an overall frequency of 2.6%. A ruptured aneurysm was located in the anterior circulation in 14 and in the posterior circulation in the other 2. The behavioral response of the 16 aSAH-afflicted drivers is shown in Figure 1. Five drivers (31%) lost control of their vehicle, causing an RTA. All of the five drivers were found unresponsive in his/her vehicle, and a call for EMS had been made either by police officers or by witnesses of the RTA. The other 11 drivers (69%) avoided an RTA by pulling over. Among them, six made an emergency call by themselves or drove to a nearby ED. However, the other five drivers were unable to make an emergency call. Mostly, passersby who found the driver lying unconscious behind the wheel made an emergency call. Regarding the outcomes evaluated at discharge, 13 drivers had a Modified Rankin Scale score of 3 or less...

Language: en