_id

683a1648c782e11e38d1b306

id

10373

title

ACEP ED COVID-19 Management Tool

full_title

ACEP ED COVID-19 Management Tool

short_title

ACEP ED COVID-19 Management Tool

med_description

Emergency department classification and management tool for adult patients (greater than 18 years old) with suspected or confirmed SARS-CoV-2 (v3.0, updated Fall 2023).

short_description

ED management tool for COVID-19.

slug

acep-ed-covid-19-management-tool

description

The ACEP ED COVID-19 Management Tool is an emergency department classification and management tool for adult patients (>18 years old) with suspected or confirmed SARS-CoV-2 (Covid-19).

keywords

ACEP ED COVID-19 Management Tool, ACEP

complaint

[ "Cough", "Dyspnea", "Fever" ]

formula

Recommendations for workup: Recommendations for treatment:

evidence

All current citations are listed on page 5 of the Emergency Department COVID-19 Management Tool. Summary of references as below:

Step 1 - Severity Classification

The disease severity classification utilized by this tool (Mild, Moderate, Severe, Critical) is based upon that adopted by the National Institute of Health COVID-19 Treatment Guidelines Panel which in turn is based upon an early consensus of the literature describing the disease entity initially presenting in Wuhan, China, and subsequently identified as SARS-CoV-2.  (https://www.covid19treatmentguidelines.nih.gov/).

Step 2 - Diagnostic Testing and Interpretation

This section follows NIH guidelines for testing recommendations that are maintained here: (https://www.covid19treatmentguidelines.nih.gov/overview/). Recommendations within this section will be updated as NIH makes updates to these recommendations. Evidence for exertional O2 measurement is included from (Greenhalgh 2020, Goodacre 2020, Paglia 2020).

It is recommended to utilize ACEP’s COVID-19 Field Guide section on abnormal lab values to review lab results.

Step 3 - Disposition

This section lays out appropriate disposition of the patient based on their severity classification. Most of this section was devised from consensus among the working group. Supplemental evidence was included from Banerjee 2021, links to patient educational materials from the CDC (https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/index.html), and multiple helpful links for patients from JAMA (example: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2763176).

Step 4 - Non-Pharmacologic Treatment

This section cites 8 references which include non-pharmacologic treatment of respiratory infections in general (e.g. Patchett 2021) as well as COVID-19 specifically (e.g. Banerjee 2021). It also includes a review of treatments for outpatient and inpatient COVID-19 management (https://www.covid19treatmentguidelines.nih.gov/management/). The recommendations are listed, based upon provider assessment of disease severity. Some of these recommendations are consensus-based.

Step 5 - Pharmacologic Treatment

This section is abstracted directly from the NIH COVID-19 Treatment Guidelines (https://www.covid19treatmentguidelines.nih.gov/therapies/), which are mainly evidence-based. The entries are listed by severity of disease. When provided in the NIH guidelines, the strength of the recommendation and level of evidence for the recommendation are specified. For example, for moderate, severe and critical COVID-19, the following is provided:

• Remdesivir: For hospitalized patients who require minimal supplemental oxygen (BIIa). 

Optional Step - Risk Prognostication

This step utilizes the PRIEST Score as a validated tool to predict a patient’s risk for end organ failure and/or mortality. It was a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). 22,445 patients were included who were suspected to have COVID-19 between 26 March 2020 and 28 May 2020. This tool was included because it did not require diagnostic testing (labs, imaging) as part of the evaluation of the patient. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822515/).

Optional Step - Risk Assessment

Additional risk factors that could increase the patient’s risk for severe disease, organ failure, and/or mortality can also be considered when evaluating a patient with COVID-19. The CDC maintains information that is consistently updated with data for risk associated with race/ethnicity, socioeconomic status, and healthcare resources (https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html). Additional references (Bellou 2020, Ebinger 2020, Lokken 2021, Strausz 2021, Williamson 2020, Tartof 2020) are included that summarize evidence for other risk factors.

References here:

• Haimovich AD et al. Development and Validation of the Quick COVID-19 Severity Index: A Prognostic Tool for Early Clinical Decompensation. Ann Emerg Med. 2020;76(4):442-453. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373004/ 
• Bellou V. Risk factors for adverse clinical outcomes in patients with COVID-19: A systematic review and meta-analysis. MedRxiv preprint. https://www.medrxiv.org/content/10.1101/2020.05.13.20100495v1.full-text 
• Ebinger JE et al. Pre-existing traits associated with Covid-19 illness severity. PLoS One. 2020;15(7):e0236240. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377468/ 
• Toussie D et al. Clinical and Chest Radiography Features Determine Patient Outcomes in Young and Middle-aged Adults with COVID-19. Radiology. 2020;297(1):E197-E206. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507999/ 
• Greenhalgh T et al. What is the efficacy and safety of rapid exercise tests for exertional desaturation in covid-19? April 21, 2020. Centre for Evidence-Based Medicine. https://www.cebm.net/covid-19/what-is-the-efficacy-and-safety-of-rapid-exercise-tests-for-exertional-desaturation-in-covid-19/ 
• COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. https://www.covid19treatmentguidelines.nih.gov/ 
• COVID-19 Hospitalization and Death by Race/Ethnicity. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/ hospitalization-death-by-race-ethnicity.html 
• Giannakoulis VG et al. Effect of Cancer on Clinical Outcomes of Patients With COVID-19: A Meta-Analysis of Patient Data. JCO Glob Oncol. 2020;6:799-808. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328119/ 
• Lokken EM et al. Disease Severity, Pregnancy Outcomes and Maternal Deaths among Pregnant Patients with SARS-CoV-2 Infection in Washington State [published online ahead of print, 2021 Jan 19]. Am J Obstet Gynecol. 2021;S0002-9378(21)00033-8. https://www.ajog.org/article/S0002-9378(21)00033-8/fulltext 
• Strausz S et al. Sleep apnoea is a risk factor for severe COVID-19. BMJ Open Respir Res. 2021;8(1):e000845. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804843/ 
• Williamson EJ et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430-436. https://www.nature.com/articles/s41586-020-2521-4 
• Tartof SY et al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Ann Intern Med. 2020;173(10):773-781. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429998/ 
• Goodacre S et al. Post-exertion oxygen saturation as a prognostic factor for adverse outcome in patients attending the emergency department with suspected COVID-19: a substudy of the PRIEST observational cohort study. Emergency medicine journal:emermed-2020-210528. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716294/ 
• Goodacre S, Thomas B, Sutton L, Burnsall M, Lee E, Bradburn M, et al. (2021) Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study. PLoS ONE 16(1): e0245840. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822515/ 
• Clift AK et al. COVID-19 Mortality Risk in Down Syndrome: Results From a Cohort Study Of 8 Million Adults. Annals of internal medicine, M20-4986. 21 Oct. 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592804/ 
• Putative contributions of circadian clock and sleep in the context of SARS-CoV-2 infection. Meira E Cruz M, Miyazawa M, Gozal D.Meira E Cruz M, et al. Eur Respir J. 2020 Jun 4;55(6):2001023. doi: 10.1183/13993003.01023-2020. Print 2020 Jun. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7191115 
• Pecora F, Persico F, Argentiero A, Neglia C, Esposito S. The Role of Micronutrients in Support of the Immune Response against Viral Infections. Nutrients. 2020 Oct 20;12(10):3198. doi: 10.3390/nu12103198. https://pubmed.ncbi.nlm.nih.gov/33092041/ 
• Arjona A, Sarkar DK. Evidence supporting a circadian control of natural killer cell function. Brain Behav Immun. 2006 Sep;20(5):469-76. doi: 10.1016/j. bbi.2005.10.002. Epub 2005 Nov 23. https://pubmed.ncbi.nlm.nih.gov/16309885/ 
• Campbell J.P., Turner J.E. Debunking the myth of exercise-induced immune suppression: Redefining the impact of exercise on immunological health across the lifespan. Front Immunol. 2018;9:648. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911985/ 
• Patchett D, Yang J, Northern J, Salinas M, Bauer BA. Viral Respiratory Infections: An Ounce of Prevention Is Worth a Pound of Cure. Mayo Clin Proc Innov Qual Outcomes. 2021 Feb 6. https://pubmed.ncbi.nlm.nih.gov/16155285 
• Paglia S, Nattino G, Occhipinti F, et al. The Quick Walk Test: A Noninvasive Test to Assess the Risk of Mechanical Ventilation During COVID‐19 Outbreaks. Acad Emerg Med. 2020 Dec 15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753836/#acem14180-sup-0001 
• Ghosh S, Deshwal H, Bin Saeedan M, et al. Imaging algorithm for COVID-19: A practical approach. Clin Imaging. 2021 Apr; 72: 22–30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7655027/ 
• Rubin GD, Ryerson CJ, Haramati LB, et al. The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society. Radiology (296) 1. https://pubs.rsna.org/doi/full/10.1148/radiol.2020201365 
• Kameda T, Mizuma Y, Taniguchi H. Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era. Journal of Medical Ultrasonics volume 48, pages31–43(2021). https://link.springer.com/article/10.1007/s10396-020-01074-y 
• Sjoding MW, Dickson RP, Iwashyna TJ, et al. Racial Bias in Pulse Oximetry Measurement. N Engl J Med 2020; 383:2477-2478. https://www.nejm.org/doi/full/10.1056/NEJMc2029240
• Pulse Oximeter Accuracy and Limitations: FDA Safety Communication. Date Issued: February 19, 2021. https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication 
• Guan X, Zhang B, Fu M, et al. Clinical and inflammatory features based machine learning model for fatal risk prediction of hospitalized COVID-19 patients: results from a retrospective cohort study. Ann Med 2021 Dec;53(1):257-266. https://pubmed.ncbi.nlm.nih.gov/33410720/ 
• Tjendra Y, Al Mana AF, Esejo AP. Predicting Disease Severity and Outcome in COVID-19 Patients: A Review of Multiple Biomarkers. Arch Pathol Lab Med 2020 Dec 1;144(12):1465-1474. https://pubmed.ncbi.nlm.nih.gov/32818235/ 
• Hahm CR, Lee YK, Oh DH, et al. Factors associated with worsening oxygenation in patient with non-severe COVID-19 pneumonia. Tuberc Respir Dis (Seoul) 2021 Jan 5. https://pubmed.ncbi.nlm.nih.gov/33401345/ 
• Chow DS, Glavis-Bloom J, Soun JE, et al. Development and external validation of a prognostic tool for COVID-19 critical disease. PLoS One 2020 Dec 9;15(12):e0242953. https://pubmed.ncbi.nlm.nih.gov/33296357/ 
• Payan-Pernia S, Perez LG, Sevilla AFR, et al. Absolute Lymphocytes, Ferritin, C-Reactive Protein, and Lactate Dehydrogenase Predict Early Invasive Ventilation in Patients With COVID-19. Lab Med 2020 Dec 18. https://pubmed.ncbi.nlm.nih.gov/33336243/

measurements

[]

information

refrences

{ "Clinical Practice Guidelines": [ { "href": "https://www.covid19treatmentguidelines.nih.gov/", "text": "COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health." } ], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.acep.org/corona/COVID-19-alert/covid-19-articles/covid-19-ED-management-tool-now-available/", "text": "Emergency Department COVID-19 Management Tool. American College of Emergency Physicians." } ], "Other References": [ { "href": "https://www.acep.org/COVID-19", "text": "ACEP COVID-19 Resources." }, { "href": "https://www.ajog.org/article/S0002-9378(21)00033-8/fulltext", "text": "Lokken EM et al. Disease Severity, Pregnancy Outcomes and Maternal Deaths among Pregnant Patients with SARS-CoV-2 Infection in Washington State [published online ahead of print, 2021 Jan 19]. Am J Obstet Gynecol. 2021;S0002-9378(21)00033-8." }, { "href": "https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/", "text": "Bhimraj A, Morgan RL, Shumaker AH, Lavergne V, Baden L, Cheng VC, Edwards KM, Gandhi R, Gallagher J, Muller WJ, O'Horo JC, Shoham S, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Infectious Diseases Society of America 2021; Version 4.1.1." }, { "href": "https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html", "text": "COVID-19 Hospitalization and Death by Race/Ethnicity. Centers for Disease Control and Prevention." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373004/", "text": "Haimovich AD et al. Development and Validation of the Quick COVID-19 Severity Index: A Prognostic Tool for Early Clinical Decompensation. Ann Emerg Med. 2020;76(4):442-453." }, { "href": "https://www.medrxiv.org/content/10.1101/2020.05.13.20100495v1.full-text", "text": "Bellou V. Risk factors for adverse clinical outcomes in patients with COVID-19: A systematic review and meta-analysis. MedRxiv preprint." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377468/", "text": "Ebinger JE et al. Pre-existing traits associated with Covid-19 illness severity. PLoS One. 2020;15(7):e0236240." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507999/ ", "text": "Toussie D et al. Clinical and Chest Radiography Features Determine Patient Outcomes in Young and Middle-aged Adults with COVID-19. Radiology. 2020;297(1):E197-E206." }, { "href": "https://www.cebm.net/covid-19/what-is-the-efficacy-and-safety-of-rapid-exercise-tests-for-exertional-desaturation-in-covid-19/", "text": "Greenhalgh T et al. What is the efficacy and safety of rapid exercise tests for exertional desaturation in covid-19? April 21, 2020. Centre for Evidence-Based Medicine." }, { "href": "https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/", "text": "Clinical spectrum. COVID-19 Treatment Guidelines." }, { "href": "https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/ hospitalization-death-by-race-ethnicity.html", "text": "COVID-19 Hospitalization and Death by Race/Ethnicity. Centers for Disease Control and Prevention." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328119/", "text": "Giannakoulis VG et al. Effect of Cancer on Clinical Outcomes of Patients With COVID-19: A Meta-Analysis of Patient Data. JCO Glob Oncol. 2020;6:799-808." }, { "href": "https://www.ajog.org/article/S0002-9378(21)00033-8/fulltext", "text": "Lokken EM et al. Disease Severity, Pregnancy Outcomes and Maternal Deaths among Pregnant Patients with SARS-CoV-2 Infection in Washington State [published online ahead of print, 2021 Jan 19]. Am J Obstet Gynecol. 2021;S0002-9378(21)00033-8." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804843/", "text": "Strausz S et al. Sleep apnoea is a risk factor for severe COVID-19. BMJ Open Respir Res. 2021;8(1):e000845." }, { "href": "https://www.nature.com/articles/s41586-020-2521-4", "text": "Williamson EJ et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430-436." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429998/", "text": "Tartof SY et al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Ann Intern Med. 2020;173(10):773-781." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716294/", "text": "Goodacre S et al. Post-exertion oxygen saturation as a prognostic factor for adverse outcome in patients attending the emergency department with suspected COVID-19: a substudy of the PRIEST observational cohort study. Emergency medicine journal:emermed-2020-210528." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822515/", "text": "Goodacre S, Thomas B, Sutton L, Burnsall M, Lee E, Bradburn M, et al. (2021) Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: The PRIEST observational cohort study. PLoS ONE 16(1): e0245840." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592804/", "text": "Clift AK et al. COVID-19 Mortality Risk in Down Syndrome: Results From a Cohort Study Of 8 Million Adults. Annals of internal medicine, M20-4986. 21 Oct. 2020." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7191115", "text": "Putative contributions of circadian clock and sleep in the context of SARS-CoV-2 infection. Meira E Cruz M, Miyazawa M, Gozal D.Meira E Cruz M, et al. Eur Respir J. 2020 Jun 4;55(6):2001023. doi: 10.1183/13993003.01023-2020. Print 2020 Jun." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/33092041/", "text": "Pecora F, Persico F, Argentiero A, Neglia C, Esposito S. The Role of Micronutrients in Support of the Immune Response against Viral Infections. Nutrients. 2020 Oct 20;12(10):3198. doi: 10.3390/nu12103198." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/16309885/", "text": "Arjona A, Sarkar DK. Evidence supporting a circadian control of natural killer cell function. Brain Behav Immun. 2006 Sep;20(5):469-76. doi: 10.1016/j. bbi.2005.10.002. Epub 2005 Nov 23." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911985/", "text": "Campbell J.P., Turner J.E. Debunking the myth of exercise-induced immune suppression: Redefining the impact of exercise on immunological health across the lifespan. Front Immunol. 2018;9:648." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/16155285", "text": "Patchett D, Yang J, Northern J, Salinas M, Bauer BA. Viral Respiratory Infections: An Ounce of Prevention Is Worth a Pound of Cure. Mayo Clin Proc Innov Qual Outcomes. 2021 Feb 6." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753836/#acem14180-sup-0001", "text": "Paglia S, Nattino G, Occhipinti F, et al. The Quick Walk Test: A Noninvasive Test to Assess the Risk of Mechanical Ventilation During COVID‐19 Outbreaks. Acad Emerg Med. 2020 Dec 15." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7655027/", "text": "Ghosh S, Deshwal H, Bin Saeedan M, et al. Imaging algorithm for COVID-19: A practical approach. Clin Imaging. 2021 Apr; 72: 22–30." }, { "href": "https://pubs.rsna.org/doi/full/10.1148/radiol.2020201365", "text": "Rubin GD, Ryerson CJ, Haramati LB, et al. The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society. Radiology (296) 1." }, { "href": "https://link.springer.com/article/10.1007/s10396-020-01074-y", "text": "Kameda T, Mizuma Y, Taniguchi H. Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era. Journal of Medical Ultrasonics volume 48, pages31–43(2021)." }, { "href": "https://www.nejm.org/doi/full/10.1056/NEJMc2029240", "text": "Sjoding MW, Dickson RP, Iwashyna TJ, et al. Racial Bias in Pulse Oximetry Measurement. N Engl J Med 2020; 383:2477-2478." }, { "href": "https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication", "text": "Pulse Oximeter Accuracy and Limitations: FDA Safety Communication. Date Issued: February 19, 2021." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/33410720/", "text": "Guan X, Zhang B, Fu M, et al. Clinical and inflammatory features based machine learning model for fatal risk prediction of hospitalized COVID-19 patients: results from a retrospective cohort study. Ann Med 2021 Dec;53(1):257-266." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/32818235/", "text": "Tjendra Y, Al Mana AF, Esejo AP. Predicting Disease Severity and Outcome in COVID-19 Patients: A Review of Multiple Biomarkers. Arch Pathol Lab Med 2020 Dec 1;144(12):1465-1474." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/33401345/", "text": "Hahm CR, Lee YK, Oh DH, et al. Factors associated with worsening oxygenation in patient with non-severe COVID-19 pneumonia. Tuberc Respir Dis (Seoul) 2021 Jan 5." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/33296357/", "text": "Chow DS, Glavis-Bloom J, Soun JE, et al. Development and external validation of a prognostic tool for COVID-19 critical disease. PLoS One 2020 Dec 9;15(12):e0242953." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/33336243/", "text": "Payan-Pernia S, Perez LG, Sevilla AFR, et al. Absolute Lymphocytes, Ferritin, C-Reactive Protein, and Lactate Dehydrogenase Predict Early Invasive Ventilation in Patients With COVID-19. Lab Med 2020 Dec 18." }, { "href": "https://www.acep.org/corona/covid-19-field-guide/assessment/laboratory-abnormalities/", "text": "ACEP COVID-19 Field Guide. American College of Emergency Physicians." }, { "href": "https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html", "text": "CDC. Healthcare workers. Centers for Disease Control and Prevention." }, { "href": "https://www.covid19treatmentguidelines.nih.gov/management/", "text": "Management. COVID-19 Treatment Guidelines." }, { "href": "https://www.covid19treatmentguidelines.nih.gov/therapies/", "text": "Therapies. COVID-19 Treatment Guidelines." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062911/", "text": "Suh EH, Lang KJ, Zerihun LM. Modified PRIEST score for identification of very low-risk COVID patients. Am J Emerg Med. 2021;47:213-216." } ], "Validations": [] }

pearls

• This algorithm is not intended as a substitute for clinicians' clinical judgement.

• This algorithm is not exhaustive in regards to diagnostic and treatment recommendations for patients with COVID-19 and COVID-like illness. 

• Patients presenting with symptoms conditions that may be manifestations of COVID-19 may also be manifestations of other serious disease (e.g. MI, PE, stroke), requiring additional specific diagnostic and therapeutic interventions not discussed in this tool.

• This ACEP ED COVID-19 Management Tool was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number 1 NU50CK000570). The CDC is an agency within the Department of Health and Human Services (HHS). The contents of this ACEP tool do not necessarily represent the policy of CDC or HHS and should not be considered an endorsement by the Federal Government.

usecase

To guide severity classification, risk stratification, diagnostic, and management decisions in adult patients (≥18 years old) with suspected or confirmed SARS-CoV-2 (COVID-19) infection in the emergency department.

reasons

This algorithm provides a pragmatic framework for standardizing severity classification, risk assessment, diagnostic workup, disposition, and treatment of adult patients  with suspected or confirmed SARS-CoV-2 (COVID-19).

next_advice

Patients presenting with symptoms conditions that may be manifestations of severe or critical COVID-19 may also be manifestations of other diseases (e.g. MI, PE, stroke), requiring additional specific diagnostic and therapeutic interventions.

next_actions

• There is no need to apply this tool to patients who are not being evaluated for COVID-19.

• If the patient is considered mild disease, this tool may help avoid further testing.

next_management

• Refer to step 5 of the ACEP ED COVID-19 Management Tool for pharmacologic treatment recommendations.

• Imaging, lab tests, treatment and disposition should be considered based on severity and risk for disease progression. 

• ACEP maintains information on laboratoratory findings at hospital admission, laboratory abnormalities in severe disease, and hypercoaguability in the ACEP COVID-19 Field Guide section on laboratory abnormalities.

• The CDC has more information on how race, ethnicity, and access to health care resources may affect outcomes. 

• AJOG has published a guideline to assist with risk stratification of pregnant patients. 

• The NIH maintains recommendations for appropriate diagnostic testing. 

• Recommendations for respiratory support, IV fluids, and other interventions are maintained by the NIH here.

• Pharmacologic recommendations for patients with COVID-19 are evolving quickly. Medication recommendations are maintained by the NIH and IDSA.

diseases

[ "Coronavirus", "COVID-19" ]

input_schema

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instructions

• This is intended for patients 18 years and older.

• Evidence on this topic is evolving quickly and may change.

published

2022-04-21T20:28:51.198Z

purpose

[ "Algorithm", "Diagnosis", "Prognosis", "Treatment" ]

search_terms

[ "ACEP ED COVID-19 Management Tool, ACEP" ]

seo

{ "keywords_en": "ACEP ED COVID-19 Management Tool, ACEP", "meta_description_en": "The ACEP ED COVID-19 Management Tool is an emergency department classification and management tool for adult patients (>18 years old) with suspected or confirmed SARS-CoV-2 (Covid-19)." }

specialty

[ "Critical Care", "Emergency Medicine", "Hospitalist Medicine", "Infectious Disease", "Internal Medicine", "Pulmonology" ]

departments

[ "Respiratory" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 10369, "short_title_en": "PRIEST Score for COVID-19", "slug": "priest-covid-19-clinical-severity-score" }, { "calcId": 10286, "short_title_en": "Brescia-COVID Severity Scale", "slug": "brescia-covid-respiratory-severity-scale-bcrss-algorithm" }, { "calcId": 10285, "short_title_en": "Brescia-COVID Score", "slug": "brescia-covid-respiratory-severity-score" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "pulmonology" ]

cleaned_use

[ "To guide severity classification, risk stratification, diagnostic, and management decisions in adult patients (≥18 years old) with suspected or confirmed SARS-CoV-2 (COVID-19) infection in the emergency department." ]

pub

false