Table 1 Referral criteria for children with COVID-19
From: Criteria for referral of pediatric SARS-CoV-2 infection: a real-life experience in the pandemic era
Patient assessment | Supportive care | Setting of care | Referral | |
|---|---|---|---|---|
Asymptomatic infection | None | None | Discharge at home, refer to the family pediatrician with indications on isolation | No |
Pauci-symptomatic/ uncomplicated case | Oxygen saturation | None In case of fever > 38 °C: paracetamol | Discharge at home, refer to the family pediatrician with indications on isolation | No |
Moderate case | • Monitor vital signs (Bedside-PEWS) • Blood tests: full blood count, C-reactive protein, erythrocyte sedimentation rate, procalcitonin, liver enzymes, lactate dehydrogenase, creatine phosphokinase, creatinine, electrolytes, hemogasanalysis, coagulation tests (prothrombin time, partial thromboplastin time, fibrinogen, D-dimers, INR) • Pulmonary ultrasound (if available) • Chest x-ray in selected cases • Other tests based on the clinical picture | • Airway suction in case of obstruction • Oxygen therapy using nasal cannulas or facial mask with Venturi system (if oxygen saturation in air < 95%) • Intravenous access, adequate fluid and caloric intake based on hydration status • Give paracetamol in case of fever > 38 °C | Hospitalization, isolation in single room with closed door | If the score (Bedside-PEWS) is not improved or increases after 2 h since oxygen and hydration support, refer the patient to a tertiary care hospital Refer to a tertiary-care hospital if: - presence of alarm criteria - needing for Venturi mask or High Flow Nasal Cannula to maintain SpO2 > 95% - relevant hematological alterations Referral should always be agreed with the infectious disease specialist |
Severe case | • Monitor vital signs (Bedside-PEWS) in order to early identify warning indicators: - respiratory rate > 60 breaths/minute < 3 months; > 50 breaths /minute 3–12 months; > 40 breaths /minute 1–5 years; > 30 breaths/ minute > 5 years - SpO2 92–93% with FiO2 ≥ 40% - Poor mental reaction and drowsiness - Increases of liver tests, muscular and cardiac enzymes - Metabolic acidosis - Bilateral interstitial infiltrates, pleural effusion on chest x-ray; rapid progression of radiological findings • Blood tests: full blood count, C-reactive protein, erythrocyte sedimentation rate, procalcitonin, ferritin, liver enzymes, lactate dehydrogenase, creatine phosphokinase, creatinine, electrolytes, hemogasanalysis, coagulation tests (prothrombin time, partial thromboplastin time, fibrinogen, D-dimers, INR), myocardial enzymes • Pulmonary ultrasound (if available) • Chest x-ray • Computer tomography scan in selected cases • Other tests based on the clinical picture | • Airway suction in case of obstruction • Oxygen therapy using nasal cannulas or facial mask with Venturi system or High Flow Nasal Cannula (target oxygen saturation > 95%) • Intravenous access, adequate fluid and caloric intake based on hydration status. Monitor urinary output. • Give paracetamol in case of fever > 38 °C • Avoid empiric antibiotic treatment if no evidence of bacterial infection (consult an infectious disease specialist or refer to hospital guidelines) | Hospitalization, isolation in negative pressure room or, if not available, in single room with closed door Intensive care admission indicated if warning signs does not improve after 2 h of patient support | Refer directly the patient to the tertiary care hospital Referral should always be agreed with the infectious disease and intensive care specialists |