Abstract Rationale, aims and objectives During the COVID-19 pandemic, in order to keep schools open and reduce SARS-CoV spreading, it is necessary to identify and isolate early SARS-CoV-2 positive paediatric patients (PP). The aim of this study was to describe the appropriateness of school hot spot (HS) setting for SARS-CoV 2 testing based on open access of PP. Method A cross-sectional study was performed between September 2020 and March 2021 among a sample of 13,283 PP in four different hospital settings. We collected: date of swab execution, type of swab, execution setting of the swab, result of the swab, information about community spread of the virus in the 14 days prior to the swab execution, sex and age. Results In Our sample, females were 45.8%. The swabs executed in all the hospital settings had a lower likelihood of resulting positive compared with the school HS setting. New-borns below 3 months and patients aged between 11 and 13 years old reported a higher probability of a swab tested positive compared to adolescents. Instead, children aged between 3 months and 2 years and aged between 3 years and 5 years were less likely to result positive. Conclusion We found a high prevalence of PP positive to the test for the detection of SARS-CoV-2 at the school hot spot compared with other settings. The open access modality to the nasopharyngeal swab was effective in identifying PP with COVID-19. Public health authorities should implement these testing modality in order to reduce SARS-CoV-2 infections in school settings.