UW Medicine Emergency Department Risk Assessment Algorithm for COVID-19

Symptomatic COVID-19+ or PUI

Stable Vital Signs Abnormal Vital Signs

Without O2 Requirement and/or O2 Requirement
(≥94%) (<94%)

Increased Risk Moderate illness Critical illness

Low Risk
- Risk Factors or abnormal SPO2 ≥94% and SPO2 <94% and/or
-No Risk Factors and unstable vitals on 5L
physical exam stable vitals on ≤ 5L
normal physical by Nasal Cannula
by Nasal Cannula
exam -COVID-19 Test*
-Rapid -Rapid Influenza/RSV
-Rapid Influenza/RSV -Rapid Influenza/RSV, COVID
Influenza/RSV per per clinical judgement
and/or COVID-19 Test Labs, and COVID Imaging per
per clinical judgment*
clinical judgement
clinical judgement -COVID-19 Test
-COVID-19 Test
-COVID Labs
-COVID Labs
Considerable Risk -COVID Imaging
Consider Discharge* NO# Factors and/or YES -COVID Imaging
-10L O2 by face mask
with COVID-19 considerable Risk
Isolation
-Admit COVID-19 or intubation and
Factors for Progression
Instructions Hospitalist# Admit ICU#
to Severe Disease
* See UW med ID testing recommendations. Consider COVID-19 testing and/or special discharge assistance for pregnant women, people living homeless
or in congregant facilities, for those with known positive exposures, and healthcare workers. # for confirmed COVID-19 +, consider ID consult for
hydroxychloroquine for patients with hypoxia or patients with risk factors without hypoxia.
Risk Factors COVID labs COVID Imaging Risk Factors for Progression to
Severe Disease
Age ≥ 60 CBC with diff Consider the following:
D-Dimer > 1.0 ug/ml
Comorbidities: HTN, CVD,
CMP 1.Portable Chest Xray CPK > 2x ULN
cardiomyopathy, pulmonary
disease, Renal disease, DM, CRP 2.POC Lung Ultrasound CRP > 100, LDH >245
transplant.

Immune deficiency: immune

LDH 3. Chest CT only if Hepatic Transaminase elevation
modulators, above imaging is New Creatinine elevation
DIC Panel (PT, aPTT,
immunosuppressive inconclusive or
medications including fibrinogen, D-dimer) Troponin elevation
considering alternative
corticosteroid treatment at the
Cardiac: ECG, CPK, diagnosis (trauma, PE, Abs lymphocyte count <0.8
equivalent of 20 mg of oral
prednisone or more daily, Troponin, and BNP dissection, ACS)
Lactate > 4
detectable HIV VL or CD4
count<200 cells/mm3) Venous lactate Extensive bilateral and/or
worsening pulmonary infiltrates
Altered mental status (GCS < 15) With pneumonia =
blood cultures Exertional SPO2 <90% during one-
Evidence of Lower Respiratory minute walk in place or unable to
Tract Infection complete.
Adapted from: CDC, WHO, UW Medicine guidelines, Cornell ED COVID guide, MGH ICU guide for COVID-19, and available literature.
1. CDC coronavirus clinical guidelines: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
2. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. March 2020
3. Zhou F, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China…The Lancet. 2020 Mar 11.
Updated March 31, 2020(Version 2.0)