Post-licence driver education for the prevention of road traffic crashes

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Abstract
Worldwide, each year over a million people are killed and some ten million people are permanently disabled in road traffic crashes. Post‐licence driver education is used by many as a strategy to reduce traffic crashes. However, the effectiveness of post‐licence driver education has yet to be ascertained. To quantify the effectiveness of post‐licence driver education in reducing road traffic crashes. We searched the following electronic databases: the Cochrane Injuries Group's Specialised Register, Cochrane CENTRAL Register of Controlled Trials, MEDLINE, EMBASE, TRANSPORT (NTIS, TRIS, TRANSDOC, IRRD), Road Res (ARRB), ATRI, National Research Register, PsycInfo, ERIC, C2‐SPECTR, Zetoc, SIGLE, Science (and Social Science) Citation Index. We searched the Internet, checked reference lists of relevant papers and contacted appropriate organisations. The search was not restricted by language or publication status. The search was last updated in October 2005. Randomised controlled trials comparing post‐licence driver education versus no education, or one form of post‐licence driver education versus another. Two reviewers independently screened search results, extracted data and assessed methodological trial quality. We found 24 trials of driver education, 23 conducted in the USA and one in Sweden. Twenty trials studied remedial driver education. The methodological quality of the trials was poor and three reported data unsuitable for meta‐analysis. Nineteen trials reported traffic offences: pooled relative risk (RR) = 0.96, 95% confidence interval (95% CI) = 0.94, 0.98); trial heterogeneity was significant (p=<0.00001). Fifteen trials reported traffic crashes: pooled RR = 0.98 (95% CI 0.96, 1.01), trial heterogeneity was not significant (p=0.75). Four trials reported injury crashes: pooled RR = 1.12 (95% CI 0.88, 1.41), trial heterogeneity was significant (p=<0.00001). No one form of education (correspondence, group or individual) was found to be substantially more effective than another, nor was a significant difference found between advanced driver education and remedial driver education. Funnel plots indicated the presence of publication bias affecting the traffic offence and crash outcomes. This systematic review provides no evidence that post‐licence driver education is effective in preventing road traffic injuries or crashes. Although the results are compatible with a small reduction in the occurrence of traffic offences, this may be due to selection biases or bias in the included trials. Because of the large number of participants included in the meta‐analysis (close to 300,000 for some outcomes) we can exclude, with reasonable precision, the possibility of even modest benefits. 駕駛人持照後教育以預防道路交通碰撞事件 在全世界的道路交通碰撞事件中，每年有超過100萬人死亡且約有1,000萬人終身失能。駕駛人持照後教育被作為一種策略以減少交通碰撞。然而，駕駛人持照後教育的效果尚未被確定。 量化駕駛人持照後教育以減少道路交通碰撞事件的效果。 我們搜尋了以下的電子資料庫:the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, TRANSPORT (NTIS, TRIS, TRANSDOC, IRRD), Road Res (ARRB), ATRI, National Research Register, PsycInfo, ERIC, SPECTR, Zetoc, SIGLE, Science (and Social Science) Citation Index。我們搜尋了網路、檢閱相關報告的文獻清單並連絡合適的機構。搜尋方法不局限語言或發表狀態。 比較駕駛人持照後教育對照無教育；或某一類型的駕駛人持照後教育對照另一類型的隨機對照試驗。 兩位檢閱者獨立地篩選研究結果、擷取資料並評估試驗的方法學品質。 我們找到24篇駕駛人教育的試驗，23篇在美國完成，一篇在瑞典完成。 20篇試驗研究有關補救性的駕駛人教育。其方法學的品質不佳，且3篇報告的資料不適合進行統合分析。 19篇試驗報告交通犯罪行為:pooled relative risk (RR) = 0.96，95%信賴區間(95% CI) = 0.94至0.98；試驗間的異質性具有顯著差異(p = <0.00001)。 15篇試驗報告有關交通碰撞:pooled RR = 0.98(95% CI 0.96, 1.01)，試驗間的異質性不具有顯著差異(p = 0.75)。 4篇試驗報告有關受傷碰撞事件:pooled RR = 1.12 (95% CI 0.88, 1.41)，試驗間的異質性具有顯著差異(p = <0.00001)。 這篇系統性的回顧無法提供駕駛人持照後教育對於預防道路交通受傷或碰撞是有效果的證據。雖然有研究結果是合適的，即在道路犯罪行為的發生有少量減少，這也許是因為選樣偏差或納入試驗的偏差造成的。由於大量的參予者被納入本統合分析中(某些結果有將近300,000人) 我們可以在合理的精確度下，把即使是較小的助益，都排除其可能性。 本摘要由高雄榮民總醫院徐圭璋翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 有力的證據顯示進階的或補救的駕駛人教育並不會減少道路交通碰撞或受傷。道路交通碰撞是全世界死亡和受傷的主因。由於駕駛人的失誤通常為導致交通碰撞的因素，因此駕駛人教育通常深信能夠使駕駛人較為安全。對於擁有駕照的駕駛人教育可以是對於有不良駕駛紀錄駕駛人的補救課程，或對於駕駛人總體的進階課程。它們可以通訊課程、團體化訓練或個人化訓練方式提供。本篇對多篇試驗所做的回顧發現有力的證明顯示，沒有一種類型的駕駛人教育可以使有駕照的駕駛人減少交通碰撞或受傷。