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

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Provider Resources

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

PPE and Isolation Recommendations

Mask in triage for patient and caregivers
Mask, eye protection, HH, gloves for care providers
- (gowns per symptoms)

Patient Requires Admission

All Patients 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 as indicated

Patient Stable for Discharge

Assess Risk of Influenza Complications
Based on Individual Patient Factors

Patients considered at Risk
for Influenza Complications

≤ 12 months old

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 months
or with chronic condition

Testing Recommended

12-24 months old and Moderately Ill
No Chronic Condition, Social Factor

Consider Testing

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

Send Rapid PCR Quad Panel
SARS-CoV-2, Flu A/B, RSV

Patients Considered to be at Low Risk for Influenza Complications

> 24 months old
No Chronic Condition, Social Factor

No Testing or Treatment Recommended

Consider COVID test

Rapid Quad Panel Results

POSITIVE Flu result

NEGATIVE Flu result

UNKNOWN Flu results
at time of ED Discharge

1^st dose oseltamivir in ED

No treatment

Consider treating presumptively with
- 1^st dose oseltamivir in ED
Discharge with paper prescription
Instruct family to check MyCHOP for
- test results

Posted: January 2013
Revised: December 2021
Authors: A. Weiss, MD; R. Scarfone, MD; J. Lavelle, MD; B. Ku, MD; J. Hemberger, MD; J. Molnar, CRNP; K. Cohn, MD; K. Castelo, CRNP; T. Metjian, PharmD

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.

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

Evidence