Long-Term Neurocognitive Outcomes in Pediatric Nonfatal Drowning: Results of a Family Caregiver Survey

Muslima S. Razaqyar, Eri Osta, Jonathan M. Towne, Mary D. Woolsey, Mariam Ishaque, Florence L. Chiang, Peter T. Fox

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Drowning is a leading cause of brain injury in children. Long-term outcome data for drowning survivors are sparse. This study reports neurocognitive outcomes for 154 children hospitalized following drowning. Methods: A survey for parent caregivers was distributed online. Likert scale items assessed 10 outcome variables in four domains: motor (three), perception (three), language (three), and social/emotional (one). Cluster analysis, outcome relative risk, and descriptive statistics were applied. Results: Of 208 surveys received, 154 met inclusion criteria. Coma was the most common admission status (n = 137). Cluster analysis identified three outcome groups: Mild (n = 39), Moderate (n = 75), and Severe (n = 40). Motor impairment with cognitive and perceptual sparing (deefferentation) was present in Moderate (P < 1 × 10−26) and Severe (P < 1 × 10−12) but absent in Mild. Locked-in state was endorsed in both Moderate (83%) and Severe (70%). The strongest predictor of good outcome (Mild) was hospitalization with no medical intervention (relative risk [RR] = 6.7). Responsivity on admission (RR = 4.2) or discharge (RR = 12.22) also predicted good outcome. In-hospital prognostication and counseling predicted outcome weakly (RR = 1.3) or not at all. Conclusions: Long-term outcomes in pediatric drowning ranged widely. Overall, motor impairments exceeded perceptual or cognitive (P < 1 × 10−18), with “locked-in state” endorsed in most (93 of 154). The strongest predictors of good outcome were the lack of necessity for interventions and responsivity on admission or discharge. The eponym “Conrad syndrome” is proposed for locked-in state following nonfatal drowning in children.

Original languageEnglish (US)
Pages (from-to)21-28
Number of pages8
JournalPediatric Neurology
StatePublished - Feb 2024


  • ABI
  • Anoxic brain injury
  • Conrad syndrome
  • Drowning
  • HIE
  • Hypoxic-ischemic encephalopathy
  • Locked-in state
  • Nonfatal drowning

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Developmental Neuroscience
  • Pediatrics, Perinatology, and Child Health


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