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Severe illness getting noticed sooner – SIGNS-for-Kids: developing an illness recognition tool to connect home and hospital
  1. Jonathan Gilleland1,
  2. David Bayfield2,
  3. Ann Bayliss3,4,
  4. Karen Dryden-Palmer5,
  5. Joelle Fawcett-Arsenault6,
  6. Michelle Gordon7,8,
  7. Dawn Hartfield9,
  8. Anthony Iacolucci10,
  9. Melissa Jones11,
  10. Lisa Ladouceur12,
  11. Martin McNamara2,
  12. Kristen Middaugh13,
  13. Gregory Moore14,15,
  14. Sean Murray16,
  15. Joanna Noble17,
  16. Simran Singh18,
  17. Jane Stuart-Minaret18,
  18. Carla Williams19,
  19. Christopher S Parshuram5,20
  1. 1Department of Pediatrics, Section of Pediatric Intensive Care Medicine, Alberta Children’s Hospital, Calgary, Alberta, Canada
  2. 2Department of Emergency Medicine, Georgian Bay General Hospital, Midland, Ontario, Canada
  3. 3Children’s Health Division, Trillium Health Partners, Mississauga, Ontario, Canada
  4. 4Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada
  5. 5Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
  6. 6Patient and Family Centered Care, Stollery Children’s Hospital, Edmonton, Ontario, Canada
  7. 7Department of Neonatal and Pediatric Medicine, Orillia Soldiers Memorial Hospital, Orillia, Ontario, Canada
  8. 8University of Toronto, Toronto, Ontario, Canada
  9. 9Department of Pediatrics, Division of Pediatrics, Hospital Medicine Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  10. 10Acute Care Transport Services (ACTS), Hospital for Sick Children, Toronto, Ontario, Canada
  11. 11SickKids Foundation, Hospital for Sick Children, Toronto, Ontario, Canada
  12. 12Nurse Practitioner Clinic, Georgian Bay General Hospital, Midland, Ontario, Canada
  13. 13Paediatric Critical Care Medicine, Center for Safety Research, Hospital for Sick Children, Toronto, Ontario, Canada
  14. 14Department of Obstetrics and Gynecology, Division of Newborn Care, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
  15. 15Department of Pediatrics, Division of Neonatology, University of Ottawa, Ottawa, Ontario, Canada
  16. 16NEO Kids and Family Program, Health Sciences North, Sudbury, Ontario, Canada
  17. 17Healthcare Insurance Reciprocal of Canada, Lead Clinical Risk, Healthcare Safety and Risk Management, Toronto, Ontario, Canada
  18. 18Department of Pediatrics, Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
  19. 19Canadian Patient Safety Institute, Ottawa, Ontario, Canada
  20. 20Pediatrics, Critical Care, Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Jonathan Gilleland; jonathan.gilleland{at}


Background Delays to definitive treatment for time-sensitive acute paediatric illnesses continue to be a cause of death and disability in the Canadian healthcare system. Our aim was to develop the SIGNS-for-Kids illness recognition tool to empower parents and other community caregivers to recognise the signs and symptoms of severe illness in infants and children. The goal of the tool is improved detection and reduced time to treatment of acute conditions that require emergent medical attention.

Methods A single-day consensus workshop consisting of a 17-member panel of parents and multidisciplinary healthcare experts with content expertise and/or experience managing children with severe acute illnesses was held. An a priori agreement of ≥85% was planned for the final iteration SIGNS-for-Kids tool elements by the end of the workshop.

Results One hundred percent consensus was achieved on a five-item tool distilled from 20 initial items at the beginning of the consensus workshop. The final items included four child-based items consisting of: (1) behaviour, (2) breathing, (3) skin, and (4) fluids, and one context-based item and (5) response to rescue treatments.

Conclusions Specific cues of urgent child illness were identified as part of this initial development phase. These cues were integrated into a comprehensive tool designed for parents and other lay caregivers to recognise the signs of serious acute illness and initiate medical attention in an undifferentiated population of infants and children. Future validation and optimisation of the tool are planned.

  • pediatrics
  • parents
  • assessment
  • early warning system
  • healthcare delivery
  • access to care

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  • Contributors JG: member of the expert panel that participated in the consensus workshop process; primary and corresponding author of the manuscript; DB, AB, KD-P, JF-A, MG, DH, AI, MJ, LL, MM, KM, GM, SM, JN, SS, JS-M, CW, CSP: members of the expert panel that participated in the consensus workshop process; contributed to and approved the final version of the manuscript.

  • Funding Travel and lodging compensation (if necessary) to attend the one day consensus workshop was provided by the Canadian Patient Safety Institute and the Health Insurance Reciprocal of Canada.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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