Perioperative Research into Memory (PRiMe): Cognitive impairment following a severe burn injury and critical care admission, part 1

Edward J R Watson; Klára Nenadlová; Olivia H Clancy; Mena Farag; Naz A Nordin; Agnes Nilsen; Ashley R T Mehmet; Ahmed Al-Hindawi; Sundhiya Mandalia; Lisa M Williams; Trudi L Edginton; Marcela P Vizcaychipi

doi:10.1016/j.burns.2018.04.011

Perioperative Research into Memory (PRiMe): Cognitive impairment following a severe burn injury and critical care admission, part 1

Burns. 2018 Aug;44(5):1167-1178. doi: 10.1016/j.burns.2018.04.011. Epub 2018 May 8.

Affiliations

¹ Magill Department of Anaesthesia, Pain Medicine and Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK. Electronic address: edward.watson@imperial.ac.uk.
² Magill Department of Anaesthesia, Pain Medicine and Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Psychology Department, Westminster University, London, UK.
³ Magill Department of Anaesthesia, Pain Medicine and Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
⁴ Magill Department of Anaesthesia, Pain Medicine and Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Anaesthesia, Watford General Hospital, West Hertfordshire Hospitals NHS Trust, UK.
⁵ Magill Department of Anaesthesia, Pain Medicine and Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK.
⁶ Psychology Department, Westminster University, London, UK; Department of Psychology, City, University of London, UK.

PMID: 29752016
DOI: 10.1016/j.burns.2018.04.011

Abstract

Introduction: An investigation into long-term cognitive impairment and Quality of Life (QoL) after severe burns.

Methods: A proof of principle, cohort design, prospective, observational clinical study. Patients with severe burns (>15% TBSA) admitted to Burns ICU for invasive ventilation were recruited for psychocognitive assessment with a convenience sample of age and sex-matched controls. Participants completed psychological and QoL questionnaires, the Cogstate^® electronic battery, Hopkins Verbal Learning, Verbal Fluency and Trail making tasks.

Results: 15 patients (11M, 4F; 41±14 years; TBSA 38.4%±18.5) and comparators (11M, 4F; 40±13 years) were recruited. Burns patients reported worse QoL (Neuro-QoL Short Form v2, patient 30.1±8.2, control 38.7±3.2, p=0.0004) and cognitive function (patient composite z-score 0.01, IQR -0.11 to 0.33, control 0.13, IQR 0.47-0.73, p=0.02). Compared to estimated premorbid FSIQ, patients dropped an equivalent of 8 IQ points (p=0.002). Cognitive function negatively correlated with burn severity (rBaux score, p=0.04). QoL strongly correlated with depressive symptoms (Rho=-0.67, p=0.009) but not cognitive function.

Conclusions: Severe burns injuries are associated with a significant, global, cognitive deficit. Patients also report worse QoL, depression and post-traumatic stress. Perceived QoL from cognitive impairment was more closely associated with depression than cognitive impairment.

Keywords: Cognitive impairment; Critical illness; Mental health; Quality of Life; Severe burns.

Publication types

Observational Study

MeSH terms

Adult
Attention*
Burns / psychology*
Cognitive Dysfunction / physiopathology
Cognitive Dysfunction / psychology*
Cohort Studies
Critical Care
Depression / psychology*
Executive Function*
Female
Hospitalization
Humans
Intensive Care Units
Language
Male
Memory, Short-Term*
Mental Health
Mental Recall*
Middle Aged
Neuropsychological Tests
Patient Health Questionnaire
Proof of Concept Study
Prospective Studies
Quality of Life
Stress Disorders, Post-Traumatic / psychology*
Trauma Severity Indices