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

Background and Objectives: 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 ten outcome variables in four domains: motor (3), perception (3), language (3), and social/emotional (1). Cluster analysis, outcome relative risk, and descriptive statistics were applied.Results: 208 surveys were received; 154 met inclusion criteria. Coma was the most common admission status (n = 137). Cluster analysis identified 3 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 x 10(-26)) and Severe groups (p <1 x 10(-12)) but absent in Mild. Congruously, locked-in state was endorsed in both the Moderate (83%) and Severe (70%) groups. The strongest predictor of good outcome (Mild group) was hospitalization with no medical intervention (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. On average, motor impairments exceeded perceptual or cognitive impairments (p <1 x 10(-18)), with "locked-in syndrome" endorsed in the majority (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's Syndrome" is proposed for locked-in state following non-fatal drowning in children. (c) 2023 Published by Elsevier Inc.