Predictors of Cognitive Function and Disability in Adult Trauma Patients who Receive Blood Transfusions

Abstract Trauma is a leading cause of death for all ages; exsanguination is the primary preventable cause of death. Standard care for hemorrhage includes infusing crystalloid and blood products. Changes occur in stored blood components affecting cellular structure and oxygenation ability; neurons are particularly sensitive to these changes. Few studies have evaluated outcomes associated with blood transfusions beyond survival and adverse events. This study will evaluate the association of blood transfusion volume, ratio of components, and age of stored blood components with cognitive/psychological functioning in trauma patients. We will use a prospective, repeated measures design, recruiting a convenience sample of critically injured adult trauma patients who receive a blood transfusion within 24 hours of admission, and one family member per patient. We will evaluate cognitive/psychological functioning once during hospitalization and again four weeks after discharge using: modified Telephone Interview for Cognitive Status (mTICS), Short Form Health Survey-36, Patient Health Questionnaire-9, Awareness Questionnaire (patient and family), and Disability Rating Scale (family member only). Paired t-tests will compare pre- and post-test scores for all instruments. Multiple linear regressions will determine the relationship between volume of transfused components and ratio of transfused blood components and resulting cognitive/psychological function at four weeks post-discharge. Logistic regression will determine the relationship between volume of transfused components and ratio of transfused blood components and resulting cognitive function (< 38 on the mTICS indicating cognitive impairment). Results could significantly influence evaluation of transfused trauma patients, and support rehabilitation and achievement of maximal functional outcomes.