Prospective Validation of a Screening Tool to Identify Older Adults in Need of a Driving Evaluation
DOI: 10.1111/jgs.15222
archive: archived pipeline: cataloged
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Summary
This prospective observational study aimed to validate and refine the five-item “CRASH” screening tool for identifying older adults who require a behind-the-wheel (BTW) driving evaluation. The motivation for this research stems from the need for a brief, valid, and simple clinical decision rule that primary care providers can use to efficiently screen at-risk drivers and prioritize BTW testing resources, as existing tools are often impractical, require family input, or lack prospective validation against objective driving outcomes. The study recruited 315 cognitively intact drivers aged 65 years and older from three primary care clinics affiliated with a tertiary care hospital. Participants completed a baseline questionnaire including the CRASH tool and standardized physical, mental, and sensory function assessments. They were then referred to an independent driving school for a one-hour BTW test administered by state-certified evaluators who were blinded to the participants’ baseline data. The primary outcome was the summary BTW rating, dichotomized as normal (pass) or abnormal (conditional pass or fail). Data analysis involved descriptive statistics, logistic regression, and Classification and Regression Trees (CART) to assess the predictive ability of the CRASH tool and to develop refined models. Results indicated that 266 participants (84%) completed the BTW test, with 83% receiving an abnormal rating and 17% a normal rating. The original CRASH tool demonstrated poor predictive performance, with an area under the receiver operating characteristic curve (AUC) of 0.51, and none of its individual variables were significantly associated with the BTW outcome. Refined models incorporating additional variables such as age, gender, self-rated health, falls, and education achieved a maximum AUC of approximately 0.67–0.68, with sensitivity and specificity around 67%. At one-month follow-up, no participants had stopped driving, though 68% of those who completed the BTW test indicated it would likely change their driving habits. Participants reported a median willingness to pay of $50 for a similar evaluation, which was lower than the retail cost of $99. The study concludes that the CRASH screening tool cannot be recommended for clinical use due to insufficient sensitivity and specificity. However, the findings highlight the perceived utility of BTW tests among older adults and the stability of driving patterns over short periods. These insights suggest that future research should focus on developing more effective screening methods and examining longer-term driving behaviors, as older drivers are more likely to modify their driving habits before ceasing driving entirely. The study underscores the ongoing challenge of balancing the need for safe driving assessments with the desire to maintain independence and mobility in an aging population.
Provenance
The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed. Discovered via author_sweep_intake on 2026-05-27.
| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | author_sweep | — | — | 2 | 2026-05-27 |
| archive | success | manual_pmc_pow_fetch | — | — | 43 | 2026-08-22 |
| extract | success | cached | — | — | 4 | 2026-08-23 |
| clean | success | clean | — | — | 1 | 2026-06-20 |
| chunk | success | chunk | — | — | 1 | 2026-06-20 |
| embed | success | embed | Qwen/Qwen3-Embedding-8B | — | 1 | 2026-06-20 |
| enrich | success | openalex | — | — | 4 | 2026-06-20 |
| promote | success | — | — | — | 1 | 2026-06-04 |
| summarize | success | llm | qwen3.8-27b-gittensor | summ-v5 | 2 | 2026-08-23 |
| tag | success | vector_similarity | — | — | 6 | 2026-06-20 |
Summary generated by qwen3.8-27b-gittensor on 2026-08-23; verification: pending re-verification.
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- Applied Guidance: countermeasure evaluation
- Methodological Resource: validation psychometrics