Influenza/Flu Clinical Pathway — Emergency | Children's Hospital of Philadelphia

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Current Influenza Activity

CDC Weekly US Map: Influenza Summary Update

Influenza-Like Illness (ILI)
Fever > 100.4°F and Cough
and/or Sore Throat
During Influenza Season

ILI Precautions

Mask in triage for patient and caregiver
ILI signage on door
Mask, gloves for care providers

Patient requires admission

ALL patients requiring admission
are considered HIGH RISK

Test and Treat Recommended
Order Rapid Flu A/B PCR

Test Result*	Action
POSITIVE	Begin oseltamivir
NEGATIVE	Do not begin oseltamivir

*If the test result is unavailable prior to floor transfer, the inpatient team can begin oseltamivir as necessary

Patient stable for discharge

For discharged patients, clinicians should determine whether to test and treat for influenza based on individual risk factors

Patient with higher risk for complications and/or likely to benefit from treatment

≤ 12 months old and/or
Chronic conditions:

Pulmonary (e.g., Asthma), cardiac, renal, hepatic, hematologic, metabolic, neurologic
Immunosuppressed, or household contact who is immunosuppressed
Long term ASA therapy
Morbid obesity
Resident of chronic care facility

Recommend Testing by Ordering Rapid Flu A/B PCR

12-24 months old and Moderately Ill¹

Consider Testing by
Ordering Rapid Flu A/B PCR

Patient at very low risk for complications and unlikely to benefit from treatment

Previously healthy children
> 24 months old¹

No Testing or Treatment

Rapid Flu A/B PCR

Test is POSITIVE

Test is NEGATIVE

Tests Results UNKNOWN
at time of ED Discharge

1st dose oseltamivir in ED
Home with 4 day paper prescription

No treatment

Treat presumptively
1st Dose Oseltamivir in ED
Home with 4 day paper prescription
Instruct family NOT to fill prescription until notified by APP
Enter APP Follow-up note to check test results
APP notifies family within next day to start treatment only if test results are positive

¹Additional Considerations

Oseltamivir most likely to be effective within 48 hours of symptom onset

Consider rapid flu test and treatment for discharged children with very young (< 6 months) or high-risk siblings with a chronic condition

Posted: January 2013
Revised: December 2014, January 2015, December 2015, December 2016, December 2017, December 2018, December 2019
Authors: A. Weiss, MD; R. Scarfone, MD; K. Feemster, MD; E. Graf, PhD; J. Molnar, CRNP; K. Cohn, MD; K. Castelo, CRNP; A. Cardenas, PhD

Evidence

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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.