Emergency Department Clinical Pathway for Screening/Evaluation of Children with Suspected 2019 Novel Coronavirus (COVID-19) Disease

Goals and Metrics
Provider Resources
Related Pathway
Current Screening for 2019 Novel Coronavirus Disease (COVID-19)
  • Patient Arrival at Greeter Desk in Emergency Waiting
    • Encounter created and exposure screen completed
    • PAC Assessment, Sort ESI Level, Place Pt ID Band
    • ED Visitation Guidance, Mask All Patients, Family Members
  • Triage PPE
  • Hand Hygiene
    • Mask + Eye Protection
No Respiratory Symptoms
Cough, SOB with or without Fever
Main ED Waiting B,C
Main ED Waiting A
Escort Patients to Next Available Room
  • AGP Existing/Likely
    • Negative Pressure Rooms as available;
    • Single room, door closed if not available
  • BH Patients
    • EDBH Rooms or
    • ECBH Rooms if eligible
Mask + Eye Protection + HH + Gloves for All Patients (Gowns per symptoms)
Modified Expanded Precautions for COVID Symptoms, COVID Exposure, Known COVID
Expanded Precautions for Aerosol-Generating Procedures, Precaution Video  
Current Testing Recommendations for SARS-CoV-2
Use ED EPIC COVID Testing Order
Patient Care Considerations
ED Asthma Pathway Changes in the setting of COVID-19
For patients requiring Asthma Treatment, MDI is preferred
Peri-Operative Guidance
Therapeutic Considerations for Patients with Severe COVID-19
Pathway for Evaluation and Treatment of Patients with Active COVID-19 Infections
  • Testing will not be done at Triage, but upon entry to room.
  • Guidance on Re-testing/Reinfection:
    • Do not repeat tests for patients with a positive PCR test in the preceding 90 days unless they have new infectious symptoms without alternate etiology and are ≥ 45 days from their initial positive test.
  • Note:
Expected Acute Hospital Admission or Procedure (Peri-Operative Guidance)
Assess Symptoms Type of Test Recommended
Symptoms Present
  • Rapid Diagnostic SARS-CoV-2 Test
  • During Influenza season send:
No Symptoms
  • Rapid Pre-admission/procedure Screening
    • SARS-CoV-2 Test
  • Including patients with admission to residential or other congregate living settings
Expected Discharge
Assess Symptoms Type of Test Recommended
Symptoms Present
  • Standard COVID Test
  • Results available 24-36 hrs after discharge
    • During Influenza season send:
  • Results
    • Available MyCHOP
    • ED APP calls for positive results
No Symptoms; Regardless of Exposure status;
Able to Mask		 No Testing
No Symptoms and Exposed And
Unable to Mask
  • Consider PCR or Antigen Test Day no earlier than 5 days post exposure

Guidance for Quarantine and Isolation for Healthy Children

CDC Guidelines  
COVID-19 Outlook: A Pandemic in Transition Requires Updated School Guidance, CHOP Policy Lab  

  • Note:
  • Children with severe COVID infection or those with weakened immune systems may require longer periods of isolation of 10-20 days, parents and patients should discuss with their individual provider.
Exposed
And
NO Symptoms
  • No quarantine if:
    • Age ≥ 18 yrs, received all recommended vaccines     OR
    • Age 5 - 17 yrs, completed primary vaccine series   OR
    • Any age, Confirmed COVID within the last 90 days
  •  
  • Wear a mask for 10 days from the date of last contact with + person and monitor symptoms
  • Consider test 5 days after last contact, pending test availability
  • If develop symptoms or have a positive test, follow isolation guidance
  •  
  • Quarantine is needed for the following people:
    • Age ≥ 18 yrs, who have not received all recommended vaccines  
    • Received single dose Johnson & Johnson over 2 months ago, and no booster
    • Anyone not vaccinated or not completed primary series
  •  
  • Wear a mask and stay home for 5 days after last contact with COVID + person and monitor symptoms
  • If symptoms develop, get tested and isolate pending test results
  • If no symptoms develop, can leave the house and return to school / daycare and continue to wear a mask for 5 days
  • Consider test 5 days after last contact, pending test availability
  • If develop symptoms or have a positive test, follow isolation guidance
  •  
  • Unable to wear mask
  • Assess ability for all children under 5 to wear a mask; if able follow above guidance
  • If unable, child must stay home 10 days after exposure, or 7 days with a negative test at day 5 or later 
  • If develops symptoms, follow isolation guidance
COVID Positive Test
or
Clinical diagnosis
of COVID
  • Isolate
  • Regardless of vaccination, stay home for 5 days
    • Day 0 is 1st day of symptoms, if no symptoms day of + test
  •  
  • If symptoms are significantly improved after 5 days of isolation, with no fever for 24 hours, child can leave the house and return to school / daycare and continue to wear a mask for 5 days
  • No additional testing is required for return to school / daycare
  •  
  • Unable to wear mask
  • Assess ability for all children under 5 to wear a mask; if able follow above guidance
  • If unable child must stay home 10 days for positive test result
Disposition
Discharge
Admission
Posted: January 2020
Revised: January 2023
Authors: K. Cohn, MD; L. Handy, MD; J. Sammons, MD; V. Kampalath MD; J. Lavelle MD; K. Chiotos, MD;
S. Myers, MD; MK. Abbadessa, ACCNS-P; S. Coffin, MD