Crashes remain the leading cause of young adult death (ages 16 to 24) with four times the number of deaths from cancer and 38 times the number of deaths from the flu. In fact, a teen’s highest lifetime risk of crashing occurs immediately following the learner phase when beginning to drive without adult supervision.
A team of researchers at The Children’s Hospital of Philadelphia Research Institute’s Center for Injury Research and Prevention (CIRP), led by Flaura Koplin Winston, MD, PhD, is taking a new tactic by addressing novice drivers’ performance and risk management from a clinical standpoint.
“As a primary care pediatrician at Karabots, I see my role as helping families to anticipate and manage health issues and ensure their children can realize their full potential,” said Dr. Winston, scientific director and founder of CIRP. “When my research showed that motor vehicle crashes accounted for one-third of all teen deaths, I looked for protocols to include driving management in my practice, but I couldn’t find them. I could not even find a valid way to assess driving performance and risk.
“This is when I knew that CHOP could take a lead on bringing our science to bear in evidence-based, evaluated ways to help families manage this exciting but dangerous phase of an adolescent’s life,” Dr. Winston continued. “Each teen approaches the driving task with assets as well as challenges, and once we figure out what they are, then we can put into place a personalized care management plan. Driving has a relatively small margin for error, and I want to do what I can to ensure that adolescents safely navigate the transition from childhood to adulthood — from the car seat to the driver’s seat.”
CIRP experts have spent many hours dissecting the factors behind why teens crash and what skills new drivers are missing. They compiled research and evidence-based practice about the major constructs around safe driving behavior. Team members also mined a massive database called the National Motor Vehicle Crash Causation Survey, and they identified the most common crash scenarios involving teen drivers.
Their work has led to the innovative concept of developing a systematic method for diagnosing driving skill level as a crucial step in personalized driving management plans. The first phase of their work is nearly complete: The team has built and validated an initial version of a Simulated Driving Assessment (SDA) tool that uses a high fidelity driving simulator located at CIRP to achieve realistic reproductions of driving experiences and conditions.
Study participants are exposed to a series of “drives” that involve variations of three main crash scenarios during a 35- to 40-minute session. The researchers collect and analyze data on numerous aspects of the drivers’ performance — from steering and braking reaction times to eye movement and headway time — and can produce an automated report.
“Some teens may have trouble with attention; some may have trouble with hand-eye coordination; some may not have the cognitive skills needed to drive safely; and due to inexperience, most have skill deficits,” Dr. Winston said. “By diagnosing driving, we want to tease out what driving deficits a teen might have before he or she crashes.”
Having a mechanism in place that gives clinicians and parents a better sense of whether or not teens are ready for independent driving is especially important in states like Pennsylvania that have laws requiring physicians to medically certify that a patient is fit to drive. If a teen has some type of medical condition that could impair his or her ability to safely operate a motor vehicle, physicians are mandated to report it to the Pennsylvania Department of Transportation.
As the CIRP team gains more experience at determining which teens could benefit the most from the SDA, Dr. Winston’s future dream is to establish a driving clinic at CHOP. Physicians could refer patients to the clinic for screening, and based on the driving diagnosis, young drivers would receive recommendations or training to help improve their performance on the road. Already, the CIRP team has published findings that show novice drivers benefit from web-based training programs that expand the diversity of the teens’ driving practice.
“CHOP is at the forefront of teen driver safety research, and it is an amazing place to take these leaps because of our interdisciplinary nature,” Dr. Winston said. “Generous funding from the Pennsylvania Department of Health allowed us to get the driving simulator and put us in a unique position to address the leading cause of death for teens.”
The CIRP team is encouraged by interest from other potential partners who support this urgently needed line of research and are looking for sponsorship to making a driving clinic at CHOP a reality.