Clinical Pathways

Nationwide Children’s Hospital’s Clinical Pathways are peer-reviewed, evidence-based best practice recommendations for the management and treatment of medical conditions. Our goal in sharing Clinical Pathways is to standardize best practices, leading to the best patient outcomes.

About Nationwide Children’s Clinical Pathways Program

  • Our Clinical Pathways are informed by national clinical practice guidelines and a review of current literature.
  • They are meant to complement clinical judgment; they are not meant to be applied rigidly in all cases. 
  • Clinical Pathways are developed by content experts, including physician and nursing leaders from medical subspecialties, and representatives from pharmacy, respiratory therapy and other allied health practitioners.

Questions can be directed to the Clinical Pathways team by email at ClinicalPathways@NationwideChildrens.org.

Behavioral Health Pavilion

Strangulation

This clinical pathway discusses the evaluation and management of patients with suspected intentional non-fatal strangulation or hanging.

Emergency Department

Acetaminophen Acute Ingestion/Overdose

This clinical pathway describes the evaluation and management of an acute acetaminophen overdose.

Acetaminophen Poisoning Due to Non-Acute/Supratherapeutic Ingestion

This clinical pathway describes the evaluation and management for a non-acute or supratherapeutic acetaminophen ingestion.

Afebrile Seizure

This clinical pathway provides the definition, differential diagnoses and management considerations for patients who present with an afebrile seizure.

Adhesive Small Bowel Obstruction

Clinical pathway for the early management of Adhesive Small Bowel Obstruction, and guidance for operative intervention using Gastrografin contrast to reduce radiation during CT scans.

Anaphylaxis

This clinical pathway describes the clinical manifestations and recommended management for patients with anaphylaxis seen in the urgent care, emergency department or admitted to the hospital.

Atopic Dermatitis

This clinical pathway describes treatment of atopic dermatitis in patients 2 months of age and older. It provides guidance on how to evaluate and treat infections, identify and treat co-existing conditions, and use of adjunctive therapies.

Bilious Emesis

A clinical pathway designed to guide prompt evaluation and surgical decision making in patients presenting with bilious emesis or imaging consistent with intestinal malrotation.

Bronchiolitis

This clinical pathway describes the definition, differential diagnosis and management of bronchiolitis in emergency department and urgent care settings.

Concussion

This clinical pathway guides the evaluation, management, and follow-up of patients with concussion.

Constipation and Fecal Impaction

This clinical pathway guides the diagnosis of constipation and fecal impaction and management of these conditions in the urgent care and emergency department.

COVID 19 Management

This clinical pathway describes the Emergency Department Management of Acute COVID 19.

Croup

This clinical pathway describes the clinical manifestations and management recommendations for patients with viral croup seen in the urgent care or emergency department.

Diabetic Ketoacidosis

This clinical pathway explores the evaluation and treatment of patients with diabetic ketoacidosis (DKA) and medium-high risk for cerebral edema in an emergency department care setting.

Distal Radius Buckle Fracture

This clinical pathway describes the management and follow-up of distal radius buckle fractures identified in the urgent care or emergency department.

Febrile Infant 22-28 Days

This clinical pathway discusses the evaluation and management of a well appearing infant (22-28 days old) in an outpatient or emergency department setting.

Febrile Infant 29-60 Days

This clinical pathway discusses the evaluation and management of a well appearing infant (29-60 days old) in an emergency department setting.

Febrile Neonate 0-21 Days

This clinical pathway discusses the evaluation and management of a well appearing febrile neonate (0-21 days old) in an emergency department setting.

Febrile Seizure

This clinical pathway describes the recommended management for patients with a febrile seizure seen in the urgent care, emergency department or admitted to the hospital.

High Risk Abdomen

Clinical pathway to support the early identification, expedient evaluation and safe disposition of “High Risk Abdomen” patients.

Infective Endocarditis

This clinical pathway describes signs and symptoms of infective endocarditis and provides recommendations for evaluation and management.

Iron Deficiency Anemia

This clinical pathway describes the evaluation and management of iron deficiency anemia in the emergency department.

Major Medical Event

This clinical pathway outlines the optimal utilization of resources in response to a major medical event.

New Onset Nephrotic Syndrome

This clinical pathway describes the diagnosis and management of new onset nephrotic syndrome in the emergency department and inpatient settings.

Non-Accidental Trauma

This clinical pathway describes indications for consideration of non-accidental trauma (NAT), differential diagnoses for specific findings, and age-based evaluation for suspected NAT in the outpatient, urgent care, emergency department and inpatient settings.

Obstetric Hemorrhage

This clinical pathway describes the management of obstetric hemorrhage in the Pediatric Emergency Department and the Maternal Fetal Medicine unit.

Obstetric Hypertensive Emergency

This clinical pathway describes the management of patients with severe range hypertension related to pregnancy.

Ovarian Torsion and Mass

A clinical pathway to guide emergency department work-up of ovarian torsion/mass evaluation, and inpatient work-up and surgical considerations for torsion, simple ovarian mass and complex ovarian mass.

Pneumonia – Suspected Community Acquired

This clinical pathway provides recommendations on the evaluation and management of community acquired pneumonia in the emergency department and urgent care settings.

Procedural Sedation

This clinical pathway discusses the use of anxiolytic, sedation, hypnotic, analgesic, and/or dissociative medication(s) to attenuate anxiety, pain, and/or motion in emergency department care settings.

Pulmonary Embolism

This clinical pathway illustrates signs and symptoms, risk factors, evaluation, and management of pulmonary embolism in the emergency department.

Pyloric Stenosis

A clinical pathway to guide evaluation of dehydration and resuscitation of hypertrophic pyloric stenosis for safe and timely operative repair, and to guide post-operative feeding and pain control to ensure a safe and timely discharge.

Rapid Sequence Intubation and Post Intubation, Sedation and Analgesia

This clinical pathway provides recommendations for rapid sequence intubation and post intubation sedation and analgesia.

Sepsis

This clinical pathway is designed to help emergency medicine providers reduce mortality among emergency department sepsis alert patients.

Solid Organ Injury

This clinical pathway outlines emergency department standard of care of patients presenting after blunt abdominal trauma and non-operative management in the inpatient care setting.

Strangulation

This clinical pathway discusses the evaluation and management of patients with suspected intentional non-fatal strangulation or hanging.

Sudden Neurologic Deterioration

This clinical pathway describes the evaluation and management of patients with new, undifferentiated neurological symptoms that include focal neurologic deficits.

Inpatient

Acetaminophen (APAP) Acute Ingestion/Overdose

This inpatient Acetaminophen Acute (dose ingested within 8 hours) Ingestion/Overdose clinical pathway outlines recommended evaluation and treatment to decrease risk of liver injury.

Acetaminophen (APAP) Poisoning due to Non-Acute/Supratherapeutic Ingestion

This inpatient clinical pathway outlines recommended evaluation and treatment to decrease risk of liver injury after Non-Acute ingestion (over > 8 hour period) of Supratherapeutic Acetaminophen doses.

Adhesive Small Bowel Obstruction

Clinical pathway for the early management of Adhesive Small Bowel Obstruction, and guidance for operative intervention using Gastrografin contrast to reduce radiation during CT scans.

Afebrile Seizure

This clinical pathway aids in the identification, diagnosis and treatment of patients presenting with a new onset, afebrile, unprovoked, convulsive seizure with specific guidance on the initial evaluation including considerations for EEG and MRI as well as indications for seizure rescue medications while ensuring proper discharge education and follow-up.

Anaphylaxis

This clinical pathway describes the clinical manifestations and recommended management for patients with anaphylaxis seen in the urgent care, emergency department or admitted to the hospital.

Bronchiolitis

This clinical pathway outlines the evaluation and management of infants and infants and children with bronchiolitis in the inpatient setting.

Children New to U.S.

This clinical pathway outlines the medical care recommendations for children new to the US (immigrant or refugee) in the inpatient care setting.

Febrile Seizure

This clinical pathway describes the recommended management for patients with a febrile seizure seen in the urgent care, emergency department or admitted to the hospital.

Constipation with Fecal Impaction

This clinical pathway discusses fecal impaction in inpatient settings.

Febrile Infant

This clinical pathway outlines the evaluation and management of a well appearing febrile neonates and infants (0 - 90 days old) in the inpatient care setting.

High Risk Abdomen

Clinical pathway to support the early identification, expedient evaluation and safe disposition of “High Risk Abdomen” patients.

Hyperkalemia

This clinical pathway outlines the evaluation and management of hyperkalemia in the inpatient setting, with the goal to efficiently and safely lower potassium to normal level with the least amount of blood draws.

Infective Endocarditis

This clinical pathway describes signs and symptoms of infective endocarditis and provides recommendations for evaluation and management.

Iron Deficiency Anemia

Appropriate evaluation and treatment of iron deficiency anemia that minimizes inappropriate blood transfusions and facilitates appropriate admissions to an inpatient unit, when indicated.

IV Fluid Therapy

This clinical pathway outlines evidence-based use of IV fluids to minimize electrolyte abnormalities and promote early transition to optimal nutrition routes.

Nephrotic Syndrome Relapse

This clinical pathway describes the management of Nephrotic Syndrome relapse.

Non-Accidental Trauma

This clinical pathway describes indications for consideration of non-accidental trauma (NAT), differential diagnoses for specific findings, and age-based evaluation for suspected NAT in the outpatient, urgent care, emergency department and inpatient settings.

Osteomyelitis – Acute Hematogenous

The inpatient Osteomyelitis clinical pathway helps to standardize the diagnostic approach to a suspected bone infection including laboratory studies, cultures and imaging considerations.

Ovarian Torsion and Mass

A clinical pathway to guide emergency department work-up of ovarian torsion/mass evaluation, and inpatient work-up and surgical considerations for torsion, simple ovarian mass and complex ovarian mass.

Pneumonia – Community Acquired

This inpatient Community Acquired Pneumonia clinical pathway provides guidance on viral versus bacterial pneumonia, recommended diagnostic evaluation and antimicrobial treatment as well as surgical intervention for complicated pneumonia.

Pyloric Stenosis

A clinical pathway to guide evaluation of dehydration and resuscitation of hypertrophic pyloric stenosis for safe and timely operative repair, and to guide post-operative feeding and pain control to ensure a safe and timely discharge.

Solid Organ Injury

This clinical pathway outlines emergency department standard of care of patients presenting after blunt abdominal trauma and non-operative management in the inpatient care setting.

NICU

Delivery Management (in the Fetal Center)

This clinical pathway discusses planned and unplanned delivery management for pregnant patients in the Fetal Center.

Inhaled Nitric Oxide

This clinical pathway discusses weaning for neonates receiving inhaled nitric oxide.

Lactation Milestones

This clinical pathway discusses lactation across a continuum that starts with early initiation of breast stimulation followed by multiple milestones leading to successful long term provision of human milk.

Therapeutic Hypothermia

This clinical pathway discusses the management of Hypoxic Ischemic Encephalopathy (HIE) in the NICU.

Outpatient

Children New to U.S.

This clinical pathway outlines the medical care recommendations for children new to the US (immigrant or refugee) in the primary care setting.

Non-Accidental Trauma

This clinical pathway describes indications for consideration of non-accidental trauma (NAT), differential diagnoses for specific findings, and age-based evaluation for suspected NAT in the outpatient, urgent care, emergency department and inpatient settings.

Surgery

Adhesive Small Bowel Obstruction

Clinical pathway for the early management of Adhesive Small Bowel Obstruction, and guidance for operative intervention using Gastrografin contrast to reduce radiation during CT scans.

Ovarian Torsion and Mass

A clinical pathway to guide emergency department work-up of ovarian torsion/mass evaluation, and inpatient work-up and surgical considerations for torsion, simple ovarian mass and complex ovarian mass.

Solid Organ Injury

This clinical pathway outlines emergency department standard of care of patients presenting after blunt abdominal trauma and non-operative management in the inpatient care setting.

Urgent Care

Afebrile Seizure

This clinical pathway provides the definition, differential diagnoses and management considerations for patients who present with an afebrile seizure.

Anaphylaxis

This clinical pathway describes the clinical manifestations and recommended management for patients with anaphylaxis seen in the urgent care, emergency department or admitted to the hospital.

Bronchiolitis

This clinical pathway describes the definition, differential diagnosis and management of bronchiolitis in emergency department and urgent care settings.

Concussion

This clinical pathway guides the evaluation, management, and follow-up of patients with concussion.

Constipation and Fecal Impaction

This clinical pathway guides the diagnosis of constipation and fecal impaction and management of these conditions in the urgent care and emergency department.

Croup

This clinical pathway describes the clinical manifestations and management recommendations for patients with viral croup seen in the urgent care or emergency department.

Distal Radius Buckle Fracture

This clinical pathway describes the management and follow-up of distal radius buckle fractures identified in the urgent care or emergency department.

Febrile Infant 22-28 Days

This clinical pathway discusses the evaluation and management of a well appearing infant (22-28 days old) in an outpatient or emergency department setting.

Febrile Seizure

This clinical pathway describes the recommended management for patients with a febrile seizure seen in the urgent care, emergency department or admitted to the hospital.

Iron Deficiency Anemia

This clinical pathway describes the evaluation and management of iron deficiency anemia in the urgent care.

Non-Accidental Trauma

This clinical pathway describes indications for consideration of non-accidental trauma (NAT), differential diagnoses for specific findings, and age-based evaluation for suspected NAT in the outpatient, urgent care, emergency department and inpatient settings.

New Onset Nephrotic Syndrome

This clinical pathway describes the diagnosis and management of new onset nephrotic syndrome in the emergency department and inpatient settings.

Ovarian Torsion and Mass

A clinical pathway to guide emergency department work-up of ovarian torsion/mass evaluation, and inpatient work-up and surgical considerations for torsion, simple ovarian mass and complex ovarian mass.

Pneumonia – Suspected Community Acquired

This clinical pathway provides recommendations on the evaluation and management of community acquired pneumonia in the emergency department and urgent care settings.

Strangulation

This clinical pathway discusses the evaluation and management of patients with suspected intentional non-fatal strangulation or hanging.

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