Table 2.

Clinical evaluation of post-COVID conditions/long COVID

Suggested procedures
Detailed history Physical examination Neurologic examination The Beighton Score for joint hypermobility [115] Physical therapy screening tests to look for limitations in symptom-free range of motion of the limbs and spine [116] Laboratory tests Complete blood count, with platelet count and differential white blood cell count Serum chemistries including electrolytes, urea, creatinine, total protein, albumin, calcium, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase T4 free, thyroid-stimulating hormone Erythrocyte sedimentation rate or C-reactive protein Ferritin or other measures of iron deficiency Vitamin B12, vitamin D Celiac disease screening Urinalysis Electrocardiogram Orthostatic testing (see below) Other testing is dependent on the history and physical examination (e.g., consider quantitative immunoglobulins in those with a history of recurrent, severe, or persistent infections; consider plasma histamine, and other tests for mast cell activation syndrome in those with a strong history of allergic inflammation or signs and symptoms of facial flushing, pruritis, or urticaria [117])
Questionnaires
Supplemental questionnaires can provide more information vital to evaluating the impact of the patient’s symptoms on their daily life. We recommend the following instruments in children and adolescents, all of which have the advantage of being brief and imposing only a minimal cognitive burden on patients: •Functional Disability Inventory [118] •Pediatric Quality of Life Inventory (Peds QL) [119] (Questionnaires exist for both the patient and an adult proxy, but a direct report from the patient is important) •Peds QL Multidimensional Fatigue Scale [120] •Wood Mental Fatigue Inventory [121] •Hospital Anxiety and Depression Scale [122] or Beck Depression Inventory [123] Our recommended battery for neuropsychologic evaluation that can be performed in person or via telehealth has been published elsewhere [17•]
Orthostatic testing
In all individuals with chronic fatigue, and at this stage of the investigation of long COVID, we recommend orthostatic testing of at least 10 min duration. This can be accomplished using either a passive standing test or a head-up tilt test
Passive standing test [95]		Laboratory head-up tilt table test [124, 125]
5 min supine—> 10 min of quiet standing with the upper back against the wall and heels 2–6 inches away from the wall—> 2 min supine		Heart rate and blood pressure were measured during a 70-degree head-up tilt 10-min tests are sufficient for diagnosing POTS and OH Prolonged testing of 40–45 min is usually required to identify neurally mediated hypotension or delayed OH
Record
Each minute	Heart rate and blood pressure *To calculate the HR increment between lowest supine and peak standing, select the lowest supine HR value from either the 5 min pre-test or the 2 min post-test
The end of the first supine phase and each minute standing	Symptoms on a 0–10 scale (0 = no symptom, 10 = worst severity) Presence of acrocyanosis