Active COVID-19, Clinical Pathway — All Settings | Children's Hospital of Philadelphia

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Provider Resources

Child with Acute COVID-19 Infection

History & Physical Exam
- Symptoms, Exposure
- Consider MIS-C
- Initiate Isolation Precautions

Multisystem Inflammatory Syndrome in Children (MIS-C)
- Guidance for Initial Evaluation of:
  - Possible MIS-C
  - Guidance for MIS-C/Shock
Neurologic Manifestations
COVID Toes

Determine Severity of Illness

Asymptomatic, Exposed

Mild/Moderate

Severe

Severe/Critical

Fever, sore throat, cough
Myalgias
No respiratory distress
No O₂ requirement
Adequate hydration

Child < 12 yrs or < 40 kg
AND child ≥ 12 yrs old
without high risk condition

Child ≥ 12 yrs and ≥ 40 kg
AND high risk condition

New O₂ requirement
- Not rapidly escalating
- Not requiring CPAP, BiPap, or intubation
Escalation in baseline respiratory support, PICU not required

Hypoxia or respiratory distress requiring
- Invasive or non-invasive ventilation
SIRS/sepsis/multisystem organ failure
Escalation in baseline
- Invasive or non-invasive ventilation requiring PICU admission
Rapidly deteriorating clinical condition that does not yet meet these criteria

Supportive Care, Discharge

Consider Outpatient Treatment

Admit to Special
Treatment Room for
COVID-positive children

Admit to PICU Special Treatment Room

Review Therapies for Non-hospitalized Children

Review Therapies for Hospitalized Children

Laboratory, Imaging Studies

Additional Inpatient Care Resources

Discharge/Deceased Care

Summary of Recent Updates to COVID-19 Therapies, 01/27/2023

Posted: June 2020
Last Revised: September 2024
Authors: K. Chiotos, MD; D. Davis, MD; C. Kerman, MD; J. Gerber, MD; J. Lavelle, MD

Evidence

Educational Media

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.

Clinical Pathway for Evaluation and Treatment of Children with Active COVID-19 Infection

Evidence

Educational Media

Clinical Pathway for Evaluation and Treatment of
Children with Active COVID-19 Infection