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To the Editor The recent study by Numé et al1 in a recent issue of JAMA Internal Medicine reports an association between prior hospitalization for syncope and increased risk of motor vehicle crashes, with subsequent recommendations for including syncope in the assessment of fitness to drive. This study differs significantly from previous studies in that the patients in this Danish nationwide cohort study were older (median age, 66 years), with a higher incidence of cardiovascular disease (34.8%).1 Thus, while the cause of syncope was not reported, this group possibly had syncope owing to another cause besides vasovagal syncope (VVS). In a study of highly symptomatic patients with VVS (mean [SD] age 38  years), there was a low incidence of VVS while driving (2 of 174 cases), with a low estimated risk of serious harm or death (<0.0035% per person-year).2
Chen-Scarabelli C, Scarabelli TM. Syncope While Driving in Denmark. JAMA Intern Med. 2016;176(8):1230. doi:10.1001/jamainternmed.2016.3723