# Referral Patterns of Pediatric Patients to Otolaryngology by Primary Care Physicians at a Single Secondary Hospital in Saudi Arabia: A Retrospective Cross-Sectional Study

## TL;DR

This study examines how often primary care doctors in Saudi Arabia refer children unnecessarily to otolaryngologists and finds that many referrals lack proper diagnostic support.

## Contribution

The study identifies specific patterns of inappropriate referrals and suggests ways to improve referral practices through training and better diagnostic access.

## Key findings

- 31.5% of pediatric otolaryngology referrals were deemed inappropriate, with nasal symptoms being the most common reason for unnecessary referrals.
- Use of diagnostic tools like tympanometry significantly increased the appropriateness of referrals.
- Children aged six to 10 were more likely to receive appropriate referrals compared to other age groups.

## Abstract

Background

Otolaryngologic conditions are among the most common reasons for pediatric visits to primary health care units. However, many referrals to otolaryngology specialists may be unnecessary, leading to potential overutilization. This study investigates referral patterns, diagnostic practices, and the appropriateness of referrals for pediatric patients at a secondary hospital in Riyadh, Saudi Arabia.

Objective

The objective of this study is to assess the demographics, reasons for referral, diagnostic approaches, and appropriateness of otolaryngology referrals for pediatric patients from primary care physicians.

Methods

A retrospective, cross-sectional analysis was conducted on 336 pediatric otolaryngology referrals (ages ≤14) from 2022 to 2024 at Prince Mohammed Bin Abdulaziz Hospital. Variables included patient demographics, referral reasons, diagnostic tools used, and final outcomes. Appropriateness of referrals was assessed, and statistical tests were performed to identify predictors of appropriate referral.

Results

The sample included 65.2% males and 96.7% Saudi nationals. The most common referral reasons were nasal symptoms (27.7%), throat symptoms (16.7%), and airway symptoms (15.2%). The most frequent diagnoses were adenoid hypertrophy with or without tonsillar disorders. About 31.5% of referrals were deemed inappropriate, with nasal complaints accounting for 73% of those. The use of diagnostic tools significantly increased referral appropriateness (p = 0.002); tympanometry, in particular, was associated with higher accuracy. Age was a significant predictor; children aged six to 10 were more likely to receive appropriate referrals (p < 0.05). No significant association was found between comorbidities and referral appropriateness.

Conclusions

A substantial proportion of pediatric otolaryngology referrals were inappropriate, especially those for nasal symptoms, which were often unsupported by diagnostic evaluation. These findings highlight a need for enhanced otolaryngology training in primary care, better access to basic diagnostic tools, and implementation of standardized referral guidelines to optimize specialist utilization and improve patient care.