ED Pathway for the Evaluation/Treatment of the Child with Flu
Influenza-Like Illness (ILI)
Fever > 100.4°F and Cough
and/or Sore Throat
During Influenza Season
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ILI Precautions
  • Mask in triage for patient and caregiver
  • ILI signage on door
  • Mask, gloves for care providers
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Patient requires admission
ALL patients requiring admission
are considered HIGH RISK
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Test and Treat Recommended
Order Direct Flu A/B RSV Test
Test ResultAction
POSITIVEBegin oseltamivir
NEGATIVERRP sent automatically
Do not begin oseltamivir
UNAVAILABLE
(after hours)
Send specimen from ED
Begin oseltamivir in ED
Test run 8am the next morning
Rapid Testing Unavailable (after hours)
Weekdays: 10:00 pm - 8:00 am
Weekends: 3:00 pm - 8:00 am
Direct Flu A/B RSV Test
Flu A: 95% sensitive
Flu B: 86% sensitive
RSV: 90% sensitive
No false positives
Patient stable for discharge
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HIGH RISK
  • Chronic conditions
  • Children < 12 months old
  • Chronic conditions:
    • pulmonary, cardiac, renal, hepatic, hematologic, metabolic, or neurologic
  • Immunosuppressed
  • < 19 year old on long-term ASA
  • American Indians/Alaska Natives
  • Morbidly obese (BMI > 40)
  • Residents of Chronic Care facilities
LOW RISK
No chronic conditions
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Consider Direct Flu A/B & RSV Test
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Test is POSITIVE
Test is NEGATIVE
Test is UNAVAILABLE
  • First dose oseltamivir in ED
  • Home with 4-day prescription
  • No ED treatment
  • RRP gets sent automatically
  • PNP follow-up note of RRP results
    • Begin oseltamivir if RRP positive
  • Treat presumptively
    without testing
  • First dose oseltamivir in ED
  • Home with 4-day prescription
USE CLINICAL JUDGMENT FOR ANTI-VIRAL TREATMENT IN HIGH RISK OUTPATIENTS BASED ON:
  • Age
  • Likelihood of influenza
  • Time since onset of symptoms
  • Disease severity progression
  • Underlying medical conditions
  • Presence of high risk household contacts
Posted: January 2013
Revised: December 2014
Authors: R. Scarfone, MD; K. Feemster, MD; K. Cohn, MD; J. Molnar, CRNP; K. Castelo, CRNP; A. Cardenas