Emergency Department and Inpatient Clinical Pathway for Evaluation of Suspected Acute Flaccid Myelitis

Related Pathways
Related Orders
  • Save Our Specimen
  • ED Suspected AFM Pathway Order Set
  • Inpatient Suspected AFM Pathway Order Set
  • Transfer from Outside Hospital
  • Ensure transfer of all imaging and verify specimens obtained
  • Key Features of AFM
  • > 1 Flaccid, floppy, low tone extremity
  • Proximal > distal weakness
  • Decreased or absent deep tendon reflexes in affected extremity
  • Cranial nerve dysfunction
    • e.g. bulbar dysfunction
  • Respiratory
  • Time of symptom onset
  • Assess for distress
    • Increased WOB, tachypnea, retractions
  • Perform NIF, VBG as clinically indicated
  • Neurologic
  • Complete exam
  • Assess for cranial nerve and/or bulbar dysfunction
    • Facial asymmetry, eye movement abnormalities, weak cough, gag, drooling, swallowing difficulty, inability to handle secretions, inability to hold head up
  • Initial Evaluation
  • Respiratory virus panel
  • NP swab or aspirate for Enterovirus
  • Consider LP in stable patients
  • CBC, CMP
  • > 48 Hours of Clinical Findings
    Without Progression of Symptoms
  • < 48 Hours of Clinical Findings
    Concern for Progressive Symptoms,
    Bulbar or Cranial Nerve Dysfunction,
    Cervical Lesions, or Abnormal NIF
Admit to Neurology
Admit to PICU
  • Treatment
  • IVIG 2 g/kg as a single dose over 1 day
  • Steroids, plasma exchange
    • Consider based on individual patient
Posted: February 2022
Revised: September 2022
Authors: S. Hopkins, MD, MSPH; M. Kirschen, MD, PhD; A. Topjian, MD, MSCE; N. Tsarouhas, MD; E. Katz, MD; J. McGuire, MD, MSCE; A. Vossough, MD, PhD; S. Swami, MD; E. Kunzelman, BSN, RN