Emergency Department Clinical Pathway for
Fever in the Returned Traveler
- Afghan Refugee
- Appendicitis, Inpatient
- Bronchiolitis, ED
- Bronchiolitis, Inpatient
- Cellulitis, Preseptal or Orbital, All Settings
- Cellulitis/Abscess, ED
- Cellulitis/Abscess, Inpatient
- COVID-19 Screening, ED
- COVID-19 Screening, Inpatient
- COVID-19 Screening, Outpatient Specialty and Primary Care
- COVID-19, Acute, All Settings
- Croup, ED
- Croup, Inpatient
- Fever
- Gastroenteritis and Dehydration, ED
- Heart Failure, Suspected, ED, ICU, Inpatient
- Influenza/Flu, ED
- Kawasaki Disease, ED and Inpatient
- Meningitis, Suspected, ED, Inpatient, ICU
- Multisystem Inflammatory Syndrome (MIS-C), Emergency, ICU and Inpatient
- Neck Space Infection, Deep, ED
- Osteomyelitis, ED and Inpatient
- Pneumonia, All Settings
- Sepsis, ED
- Sepsis, PICU
- Sepsis, CICU
- Septic Arthritis, ED
- Sexually Transmitted Infections (STI) in Adolescents, ED, Primary Care
- Urinary Tract Infection (UTI), Febrile, All Settings
Sepsis Screen Positive
- Sepsis huddle as clinically indicated
- ED Sepsis Pathway
- Consider
- Severe malaria
- Typhoid
- Dengue
Triage
- Complete:
- Epic Sepsis Screen
- Recent Travel Screen
- Infectious Disease Exposure Screen
- Infection Precautions
All Infants/Children Unvaccinated for Measles
- Mask immediately
- Expedite to AIIR
- Door remains closed for entire visits
- Regardless of symptoms or decision to test
FLOC/RN Team Assessment
- Evaluate Travel Risk
- Specific travel location
- Preventive measures, compliance
- Unusual Exposure During Travel
- Key Elements of History and Physical Exam
- Review Infection Precautions
Laboratory and Radiologic Testing
Including concern for tropical disease
Including concern for tropical disease
RDT Not Applicable
Negative RDT
Positive RDT
- Reassuring VS and PE
- No significant anemia/hemolysis
- Ability for PCP follow-up w/in 24 hrs
- Child ill-appearing or
- Neurologic signs/symptoms or
- Significant anemia (Hgb < 7, evidence of hemolysis)
Reconsider general Fever Pathway and other infectious pathways for focal infections
- Review Criteria for Severe Malaria
- Treat w/antimalarials
- Consider co-infection
- Consider empiric treatment w/broad spectrum
- antibiotics for ill-appearing children
Consult Infectious Disease
Discharge
Admission
- Ensure adequate hydration
- Reassuring VS, PE
- Fever care, specific discharge instructions
- Follow-up recommendations
Evidence
- CDC Yellow Book Approach to the Returned Traveler
- Approach to Fever in the Returned Traveler. NEJM. 2017
- Fever in the Returning Traveler, Part One: A Methodological Approach to Initial Evaluation
- Fever in Returned Travelers: Results from the GeoSentinel Surveillance Network
- Traveler Exposure to Animals: A GeoSentinel Analysis
- Illness Among US Resident Student Travelers After Return
- CDC Refugee Health Guidance
Educational Media