(1022) Otolaryngologic Sequelae Following Pediatric Traumatic Brain Injury: Incidence, Timing, and Referral Patterns

Introduction: Traumatic brain injury (TBI) is a major cause of pediatric morbidity, yet otolaryngologic sequelae and referral guidelines remain poorly defined. This study describes the frequency and timing of otolaryngologic diagnoses following pediatric TBI and quantifies Otolaryngology Head and Neck Surgery (OHNS) involvement.

Methods: We conducted a retrospective cohort study of pediatric patients ( < 18 years) diagnosed with TBI at an urban tertiary academic medical center from January 2015-2020. Data was extracted from a de-identified electronic health record database. Outcomes were defined as new OHNS diagnoses within 365 days of index TBI and categorized into clinically relevant domains. Descriptive statistics were used to characterize demographics, diagnosis incidence, and time to referral to OHNS, audiology, sleep medicine, or vestibular rehabilitation.

Results: Among 3,214 pediatric TBI patients (mean age 11.5 ± 4.8y; 54.9% male), 284 (8.8%) developed ≥1 new OHNS diagnosis within one year, with 84% having a single diagnosis. Incidence of sequelae included 5.1% vestibular/balance, 2.9% hearing disorders, 2.5% dysphagia, 1.6% voice/laryngeal, 1.5% other ear pathology, 0.4% sleep apnea, 0.3% facial nerve palsy, and 0.2% anosmia. Mean time to diagnosis was 14.5 days (IQR 0-124.8), with 38.4% within the first week. Other ear, vestibular, and dysphagia conditions were diagnosed in the first week in 58%, 49%, and 37% of cases, while 53% of hearing-related diagnoses were diagnosed between 91 and 365 days. Among patients with OHNS sequelae, 14.8% received an OHNS referral and 29.2% received an OHNS or other related referral within one year, with vestibular disorders having the lowest referral rate (1.5%).

Conclusions: One in 11 pediatric TBI patients developed OHNS diagnoses within 1 year, lower than rates reported in prospective studies using active symptom surveillance, with most lacking OHNS referral. Together, these suggest under diagnosis and critical care gaps. Variable timing across domains supports the development of longitudinal, domain-specific screening with standardized referral pathways.