INTRODUCTION: Paediatric ENT clinical negligence litigation carries significant financial and governance implications, yet remains poorly characterised. This study aimed to characterise the nature, cause, and cost of paediatric ENT claims notified to NHS Resolution and identify themes amenable to risk reduction.
METHODS: Retrospective analysis of NHS Resolution data for paediatric ENT claims (aged 0–17) notified 2018/19–2022/23. Two independent reviewers categorised each claim by subspecialty, diagnosis, age group, operative involvement, and cause code, with complete agreement. Groupings included delay in diagnosis or treatment, consent failure, operative error, and failure to perform investigations.
Results: 72 claims were identified across paediatric ENT, of which the highest proportion related to paediatric otology (54%, n=39). Cholesteatoma was the single most litigated diagnosis (32%, n=23). Delay in diagnosis was identified in 47% of claims (n=34) and delay in treatment in 15% (n=11). Claims were equally distributed between operative (50%) and non-operative (50%) contexts. Consent or information failures were identified in 17% of claims (n=12), all of which remain open. The highest estimated potential value for open claims involved delayed adenotonsillectomy resulting in hypoxic brain injury (£11.6m), and delayed diagnosis of otogenic brain abscess (£5.5m). Eight closed claims resolved without damages, incurring defence costs only (mean £1,265).
Conclusion: Cholesteatoma diagnostic delay and consent failure are the most frequent and preventable contributors to paediatric ENT litigation. These findings support standardised cholesteatoma surveillance pathways and robust consent practices in the post-Montgomery era. Half of claims arose without operative involvement, highlighting risk beyond theatre.