COVID-19 Screening Clinical Pathway — Outpatient Specialty Care and Primary Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Provider Resources

Related Pathways

Evaluation and COVID-19 Testing Guidance for Children with Respiratory Symptoms

Outpatient Specialty Care
Pre-arrival Screening
Pre-arrival Testing
Tracheostomy/Ventilator Dependent Children

Definition of Symptoms and COVID Suspected Children

Symptom Screening at Arrival

Encourage all children and families to mask in waiting room
Symptomatic children, family members remain masked throughout care except for PE as needed

Symptom-based Precautions
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 Room with door closed Contact/Droplet if COVID test negative

Expected Discharge	Expected Acute Hospital Admission or Procedure (Peri-operative Guidance)
Consider Standard SARS-CoV-2 Test for the following: Symptoms Present As clinically indicated Child/family request No symptoms + exposed, consider test if > 5 days from exposure Use Influenza Pathway to guide additional testing during influenza season	Send Rapid Diagnostic SARS-CoV-2 Test for the following: Symptoms Present, regardless of AGP Note: No admission test required for asymptomatic + AGP regardless of exposure history or 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 Guidance on Re-testing/Reinfection

Expected Discharge

Expected Acute Hospital Admission
or Procedure (Peri-operative Guidance)

Consider Standard SARS-CoV-2 Test for the following:

Symptoms Present
- As clinically indicated
- Child/family request
No symptoms + exposed, consider test if > 5 days
from exposure

Use Influenza Pathway to guide additional testing during influenza season

Send Rapid Diagnostic SARS-CoV-2 Test for the following:

Symptoms Present, regardless of AGP

Note:

No admission test required for asymptomatic + AGP regardless of exposure history or 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
Guidance on Re-testing/Reinfection

Stable for Outpatient Treatment
Transfer for Continued Evaluation

Review Discharge Instructions
- General COVID Discharge Instructions
- Respiratory Virus Guidance
Transfer as clinically indicated, Pre-notification if known COVID-19
Admissions Screening

Posted: January 2020
Revised: September 2024

Authors:
- K. Cohn, MD;
- L. Handy, MD;
- J. Sammons, MD;
- V. Kampalath MD;
- J. Lavelle, MD

Editors: Clinical Pathways Team

Evidence

Educational Media

Primary Care Perspectives: Podcast for Pediatricians
Episode 84: Coronavirus and Children with Immunodeficiencies
PEM Podcast: COVID in ISRAEL
PEM Podcast: COVID UPDATE with Dr. Paul Offit
PEM Podcast: Monday Morning Quarterback: COVID with Dr. Paul Offit

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us.

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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.

Outpatient Specialty Care and Primary Care Clinical Pathway for Screening Children with Suspected 2019 Novel Coronavirus (COVID-19) Disease

Evidence

Educational Media