ACEP COVID-19 Field Guide

Author: College of Urgent Care Medicine; and the American College of Emergency Physicians

Risk stratification guide for severity assessment and triage of suspected or confirmed COVID-19 patients (adults) in urgent care.^*

^* These criteria are to be used as an adjunct to the clinical evaluation that is performed by the clinician at the urgent care site. 

General guidelines

1. For urgent care centers that do not have COVID-19 testing capabilities, patients who are stable and want to get tested or need testing should be referred to a local non–emergency department site or facility. This is meant to decrease unnecessary patient volumes in the emergency department (Table 5.1).
2. Prior to sending patients to the emergency department, contact the emergency department to make sure that they will be able to test the patient for COVID-19. This is applicable for emergency department transfers of patients in whom COVID-19 infection is a concern.

 Presenting symptoms

• Patients may present with an uncomplicated upper respiratory tract viral infection and may have nonspecific symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore throat, dyspnea, nasal congestion, or headache. Rarely, patients may also present with diarrhea, nausea, and vomiting.
• The elderly and immunosuppressed patients may present with atypical symptoms. Symptoms due to physiologic adaptations of pregnancy or adverse pregnancy events, such as dyspnea, fever, GI symptoms, or fatigue, may overlap with COVID-19 symptoms.

Table 5.1 Risk stratification and disposition based on clinical presentation.

References

1. WHO. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance. Published 2020 Mar 13. WHO/2019-nCoV/Clinical/2020.4
2. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3