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
NEGATIVEDo 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
Patient stable for discharge
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Patient with higher risk for complications and/or likely to benefit from treatment
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  • Testing and treatment (if test is positive) should be performed if any of the following:
  • < 12 months old
  • Chronic conditions:
    • Pulmonary, cardiac, renal, hepatic, hematologic, metabolic, or neurologic
    • Immunosuppressed or household contact is immunosuppressed
    • Long term ASA therapy
    • Morbidly obese
    • Resident of chronic care facility
  • Testing and treatment (if test is positive) should be considered for previously healthy children with symptoms < 48 hrs with any of the following:
  • 12-24 months old
  • Moderately ill
Patient at very low risk for complications and unlikely to benefit from treatment
  • Previously healthy children
    > 24 months old
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No Testing or Treatment
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Direct Flu A/B & RSV Test
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Test is POSITIVE
Test is NEGATIVE
Tests Results UNKNOWN
at time of ED Discharge
Test is UNAVAILABLE
  • 1st dose oseltamivir in ED
  • Home with 4 day prescription
  • No treatment
  • Treat presumptively
  • 1st Dose Oseltamivir in ED
  • Home with 4 day prescription
  • Enter APP Follow-up note to check test results
  • APP notifies family to stop treatment if test negative
  • Treat without testing
  • Home with 4 day prescription
Posted: January 2013
Revised: December 2014, January 2015, December 2015
Authors: R. Scarfone, MD; K. Feemster, MD; K. Cohn, MD; A. Weiss, MD; J. Molnar, CRNP; K. Castelo, CRNP; A. Cardenas, PhD