Neurocognitive outcomes in survivors of severe burn injuries: A systematic review

Severe burn injuries represent one of the most devastating forms of trauma, with wide-ranging physical, psychological, and neurological consequences. Although mortality rates have declined, long-term neurocognitive outcomes remain poorly understood. This systematic review evaluates the types, severity, and duration of neurocognitive impairments among survivors of severe burn injuries and explores how these outcomes are influenced by burn severity, intensive care unit (ICU) stay, and sedation exposure.

A comprehensive literature search was conducted across PubMed, Google Scholar and Web of Science databases following a specific search strategy. All search results were screened in a two-stage process (title-abstract and full-text screening) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Data from finalized articles were extracted using a standardized Excel file. Lastly, quality and risk of bias were assessed using appropriate tools according to respective study designs, and data were narratively synthesized.

Ten studies published between 1998 and 2025 were included. The studies demonstrated significant heterogeneity in design, population, burn characteristics, and cognitive assessment tools. Cognitive impairments were most commonly identified in the domains of memory, attention, and executive function. Acute delirium was reported in up to 52% of patients, with mechanical ventilation identified as a key risk factor. Long-term cognitive deficits across memory, attention, executive function, and global cognition were consistently reported, although effect estimates varied widely across studies due to heterogeneity in study design and measurement tools. Psychological comorbidities such as depression, anxiety, and PTSD were commonly reported in association with neurocognitive disorders. While these comorbidities were not systematically evaluated in all studies, those that assessed them consistently demonstrated increased prevalence. However, the overall certainty of evidence for all outcomes was rated as very low due to serious risk of bias, indirectness, and imprecision across the included observational studies.

Survivors of severe burn injuries are at substantial risk for both acute and chronic neurocognitive impairments. Routine cognitive screening and multidisciplinary rehabilitation should be integral to post-burn care. Future research should employ standardized neurocognitive batteries, control for confounding factors, and include long-term follow-up to clarify the trajectory of recovery.