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)
  • 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:
  1. Symptoms Present, regardless of AGP
  2. 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
  • 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:
  1. Symptoms Present
    • As clinically indicated
    • Child/family request
  2. No symptoms + exposed, consider test if > 5 days from exposure

Use Influenza Pathway to guide additional testing during influenza season
Disposition
Discharge
Admission
Management of Parents and Caregivers with Exposure to or Symptoms of COVID-19
Posted: January 2020
Revised: May 2023