ALGORITHM ON THE SCREENING AND MANAGEMENT

OF PEDIATRIC COVID SUSPECT PATIENTS AT THE

EMERGENCY DEPARTMENT (Ver. 2.0. 18July2020)

ER TRIAGE
Any ONE of the following:
Influenza-like Illness: Fever Cough Colds Shortness of breath Sore throat
Headache Myalgia Arthralgia Diarrhea
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for which no other plausible alternative etiology can be considered

+ Any ONE of the following:

EXPOSURE CLINICAL LABORATORY
EVALUATION EVALUATION EVALUATION
• Exposure/close contact with sick • Rapid progression of • Laboratory and imaging results
persons with suspected or proven symptoms consistent with COVID-19
COVID-19 • Worsening respiratory
• History of travel abroad in the last 14 infection unresponsive to
days standard treatment
• History of travel to areas with • Unstable vital signs upon
localized transmission in the last 14 arrival at the ER
days • In impending respiratory
• Resides in areas with reported failure or in cardiac arrest upon
clustering of COVID cases or arrival at the ER
influenza-like illness

MAIN ER* CLEAN ER*

YES *ED Physician/Resident to assess/
admit as necessary
NO (ER chapel)
*ED Physician to assess/
admit as necessary

SEVERE/CRITICAL SUSPECTED COVID

Decision-making:
Child with cough or difficulty of ADMISSIBLE OR
breathing, plus at least ONE of the SURGICAL CASES
following:
NOT?
OTHER MEDICAL CASES:
• Central cyanosis or SpO2 <90%
• Including but not limited to non-
• Severe respiratory distress (e.g. grunting, SURGICAL CASES:
respiratory COVID-related
chest indrawing) • COVID RT-PCR for clearance
manifestations (e.g. Kawasaki-like,
• Signs of pneumonia with a general danger • Minor procedures
neurologic signs/symptoms)
sign: inability to breastfeed or drink, • Surgical emergencies
lethargy, or unconsciousness, or • Trauma cases
convulsions
• Other signs of pneumonia: fast breathing MEDICAL CASES:
(in breaths/min.) • Acute respiratory or viral
<2mos., ≥ 60 infections not COVID-related
2-11mos., ≥ 50
1-5 yrs., ≥ 40
NON-SEVERE • Hematologic/oncologic cases
• Toxicology cases

SEPSIS : suspected or proven infection and • Cases that do not satisfy the • Cases with moderate to severe
≥ 2 SIRS criteria criteria for severe/critical cases dehydration
• Child has no signs of dehydration • Non-surgical acute abdomen
Any patient presenting with SEPTIC • Laboratory results are not • Hypersensitivity reaction/allergies
SHOCK deranged

ADMIT
HOME MANAGEMENT

ADMIT TO
1. Admit to COVID ward/IMCU/ICU
HOME QUARANTINE REGULAR NON-
− Observe proper infection control measures
COVID WARD
− May stay at ER main pending room availability • Supportive management
• Monitoring • Cases not needing
2. Do COVID RT-PCR naso- • Teleconsultation with pediatrician close monitoring
oropharyngeal swab • Complete home quarantine for 14
A
days after resolution of symptoms
3. Follow COVID-19 Management
Guidelines ADMIT TO
PICU/IMCU
4. Refer to Infectious Disease
specialist
RE-EVALUATE • Cases needing
close monitoring
A
APPENDIX: DISCHARGE INSTRUCTIONS FROM ER

A. Discontinuation of Home Isolation for COVID Suspect/Probable/

Confirmed COVID-19

1. Patients with no RT-PCR test

• May discontinue home isolation when the following conditions are met (US-CDC):
a. At least 3 days (72 hours) have passed since recovery, defined as resolution of fever
without the use of fever reducing medications and improvement of respiratory
symptoms; AND
b. At least 7 days have passed since symptoms first appeared; OR
• WHO: Complete home quarantine for 14 days after resolution of symptoms


2. Patients with PCR-confirmed COVID-19
• May discontinue home isolation under the following conditions:
a. Resolution of fever without the use of fever reducing medications and improvement of
respiratory symptoms, AND
b. If with access to REPEAT TESTING:
− At least 2 consecutive NEGATIVE results for COVID-19 (naso-oropharyngeal
swab) collected ≥ 24 hours apart, from a DOH-accredited testing center





References:
1. Interim guidelines on the screening, assessment and clinical management of pediatric patients with suspected or confirmed
coronavirus disease 2019. April 2020. Pediatric Infectious Disease Society of the Philippines
2. Centers for Disease Control and Prevention. Discontinuation of home isolation for persons with COVID-19 (Interim Guidance).
Available at https://www.cdc.gov/coronavirus/2019- ncov/hcp/disposition-in-home-patients.html. Accessed on March 22,
2020.