Influenza/Flu Clinical Pathway — Emergency Department

Emergency Department Clinical Pathway for the Evaluation/Treatment of Children with Suspected Flu

Goals and Metrics
Patient Education
Provider Resources
CDC Weekly US Map:
Influenza Summary Update  
Influenza Vaccination
for Discharged Children
Influenza-like Illness (ILI)
  • Fever ≥ 100.4°F and Cough
  • and/or Sore Throat
  • During Influenza Season
 
 
PPE and Isolation Recommendations
  • Mask in triage for child and caregivers
  • Mask, eye protection, HH, gloves for care providers
    • (gowns per symptoms)
 
 
 
 
Child Requires Admission
 
 
 
 
All children requiring admission are considered at higher risk for
influenza complications
 
 
Testing Recommended
Send Rapid PCR Quad Panel
SARS-CoV-2, Flu A/B, RSV
Test Result Action
Positive Begin oseltamivir
Negative Do not begin oseltamivir
If test result is unavailable prior to floor transfer, inpatient team can begin oseltamivir when test results are available.
Child Stable for Discharge
 
 
Assess risk of influenza complications
Based on individual factors of the child
 
 
 
 
Children considered at risk
for influenza complications
 
 
 
 
< 12 mos

or
  • Chronic Conditions
  • Pulmonary (e.g., Asthma), cardiac, renal, hepatic, hematologic, metabolic, neurologic
  • Immunosuppressed
  • Long term ASA therapy
  • Morbid obesity
  • Social Factors
  • Resident of chronic care facility
  • Household contact < 6 mos
    or with chronic condition
 
 
Testing Recommended
 
 
12-24 mos Old and Moderately Ill
No chronic condition, social factor
Consider Testing
Additional Considerations:
Consider testing/treating only if symptoms are present < 48 hrs
 
 
Send Rapid PCR Quad Panel
SARS-CoV-2, Flu A/B, RSV
Children considered to be at low risk for influenza complications
> 24 mos Old
No chronic condition, social factor
No testing or treatment recommended
 
 
Rapid quad panel results
 
 
 
 
Positive flu result
Negative flu result
Flu A positive, refer to
avian influenza screening
 
 
 
 
Treatment Recommendations
No Treatment
  • < 12 mos or chronic conditions
    • Begin oseltamivir
  • 12-24 mos without chronic condition
    • Consider oseltamivir
      • Symptoms present < 48 hrs
      • Based on symptom severity
  • Note:
    • Oseltamivir most likely to be effective if given within 48 hrs of symptoms
    • After hours, provide 1st dose of oseltamivir in ED
Posted: January 2013
Revised: June 2025
Editors: Clinical Pathways Team