COVID-19 Screening Clinical Pathway — Emergency | Children's Hospital of Philadelphia

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Provider Resources

Related Pathway

Current Screening for 2019 Novel Coronavirus Disease (COVID-19)

Child Arrives at Greeter Desk in Emergency Waiting
- Encounter created and exposure screen completed
- PAC Assessment, Sort ESI Level, Place Child ID Band
- Encourage all children and families to mask in waiting room

Triage PPE
Hand Hygiene + Mask

No Respiratory Symptoms

Respiratory Symptoms Present

ED Waiting B, C

ED Waiting A

Symptom-based ED Precautions
No Known COVID Exposure
Asymptomatic	Standard
Symptomatic	Contact/Droplet, regardless of COVID test result
Symptomatic + AGP	Expanded, until COVID test result available Use negative pressure room as available or ED room with door closed
Known COVID Exposure
Asymptomatic or Symptomatic	Contact/Droplet, regardless of COVID test result
Known COVID Exposure, AGP
Asymptomatic or Symptomatic	Expanded, until COVID test result available Use negative pressure room as available or ED room with door closed

Current Testing Recommendations for SARS-CoV-2

Collection of COVID-19 Testing

Expected Acute Hospital Admission or Procedure (Peri-operative Guidance)
Send Rapid Diagnostic SARS-CoV-2 Test for the following: Symptoms Present, regardless of AGP No symptoms + Exposed + Procedure within 72 hours Note: No admission test required for asymptomatic + AGP regardless of exposure history if no scheduled procedure For children transferred to residential or other conjugate living settings, consider testing or follow guidance from individual facility Rapid Antigen Testing in Children with Current Positive COVID PCR Awaiting Transfer to Inpatient BH Setting Use Influenza Pathway to guide additional testing during influenza season

Expected Acute Hospital Admission or Procedure (Peri-operative Guidance)

Send Rapid Diagnostic SARS-CoV-2 Test for the following:

Symptoms Present, regardless of AGP
No symptoms + Exposed + Procedure within 72 hours

Note:

No admission test required for asymptomatic + AGP regardless of exposure history
if no scheduled procedure
For children transferred to residential or other conjugate living settings, consider testing or follow guidance from individual facility
Rapid Antigen Testing in Children with Current Positive COVID PCR Awaiting Transfer to Inpatient BH Setting
Use Influenza Pathway to guide additional testing during influenza season

Note: Testing will not be done at Triage, but upon entry to room.
Guidance on Re-testing/Reinfection:
- Do not repeat tests for children with a positive PCR test in the preceding 90 days unless they have new infectious symptoms without alternate etiology and are
  ≥ 31 days from their initial positive test.

Expected Discharge
Consider Standard SARS-CoV-2 Test for the following: Symptoms Present As clinically indicated Child/family request No symptoms + exposed, consider test if > 5 days from exposure Use Influenza Pathway to guide additional testing during influenza season

Expected Discharge

Consider Standard SARS-CoV-2 Test for the following:

Symptoms Present
- As clinically indicated
- Child/family request
No symptoms + exposed, consider test if > 5 days from exposure

Use Influenza Pathway to guide additional testing during influenza season

Disposition

Discharge

Admission

Use COVID-19 Discharge Smart Set if child tested
COVID Discharge Instructions
COVID-19 Return to Sports Participation for General Pediatricians and Recommendations for Cardiology
Consultation after COVID-19
Isolation and Precautions for People with COVID-19 (CDC)

Management of Parents and Caregivers with Exposure to or Symptoms of COVID-19

Posted: January 2020
Revised: July 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

Editors: Clinical Pathways Team

Evidence

Educational Media

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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

Evidence

Educational Media