Emergency Department Clinical Pathway for the Evaluation/Treatment of Children with Suspected Flu

Goals and Metrics
Patient Education

Current Influenza Activity

CDC Weekly US Map: Influenza Summary Update  

Influenza-Like Illness (ILI)
Fever > 100.4°F and Cough
and/or Sore Throat
During Influenza Season
ILI Precautions
  • Mask in triage for patient and caregiver
  • ILI signage on door
  • Mask, gloves for care providers
Patient requires admission
ALL patients requiring admission
are considered HIGH RISK
Test and Treat Recommended
Order Rapid Flu A/B PCR
Test Result* Action
POSITIVE Begin oseltamivir
NEGATIVE Do not begin oseltamivir
*If the test result is unavailable prior to floor transfer, the inpatient team can begin oseltamivir as necessary
Patient stable for discharge
For discharged patients, clinicians should determine whether to test and treat for influenza based on individual risk factors
Patient with higher risk for complications and/or likely to benefit from treatment
≤ 12 months old and/or
Chronic conditions:
  1. Pulmonary (e.g., Asthma), cardiac, renal, hepatic, hematologic, metabolic, neurologic
  2. Immunosuppressed, or household contact who is immunosuppressed
  3. Long term ASA therapy
  4. Morbid obesity
  5. Resident of chronic care facility
Recommend Testing by Ordering Rapid Flu A/B PCR
12-24 months old and Moderately Ill1
Consider Testing by
Ordering Rapid Flu A/B PCR
Patient at very low risk for complications and unlikely to benefit from treatment
Previously healthy children
> 24 months old1
No Testing or Treatment
Rapid Flu A/B PCR
Test is POSITIVE
Test is NEGATIVE
Tests Results UNKNOWN
at time of ED Discharge
  • 1st dose oseltamivir in ED
  • Home with 4 day paper prescription
  • No treatment
  • Treat presumptively
  • 1st Dose Oseltamivir in ED
  • Home with 4 day paper prescription
  • Instruct family NOT to fill prescription until notified by APP
  • Enter APP Follow-up note to check test results
  • APP notifies family within next day to start treatment only if test results are positive
1Additional Considerations

Oseltamivir most likely to be effective within 48 hours of symptom onset

Consider rapid flu test and treatment for discharged children with very young (< 6 months) or high-risk siblings with a chronic condition

Posted: January 2013
Revised: December 2014, January 2015, December 2015, December 2016, December 2017, December 2018, December 2019
Authors: A. Weiss, MD; R. Scarfone, MD; K. Feemster, MD; E. Graf, PhD; J. Molnar, CRNP; K. Cohn, MD; K. Castelo, CRNP; A. Cardenas, PhD; T. Metjian, PharmD