SIGNS for Kids

Severe Illness Getting Noticed Sooner

Severe Illness Getting Noticed Sooner

LINK to Tool

Late escalation of care for children with severe illness can lead to death or disability.
More effective engagement of Parents and other caregivers may improve illness recognition and enable prompt, life-saving treatment.
Tools to help parents identify children with severe illness are limited.


Identifying and validating the SIGNS criteria.
Integrating the SIGNS criteria into a tool to help parents identify and describe severe illness.
Implementing the SIGNS tool and evaluating child health outcomes.


The following projects were conducted in partnership with the Health Excellence Canada - formally Canadian Patient Safety Institute (CPSI) and the Health Insurance Reciprocal of Canada (HIROC)

Expert Development of the SIGNS for Kids Items. A 17-member multi-disciplinary panel from 4 provinces met in person, and using modified consensus approach articulated the 5 SIGNS for Kids items and 14 sub-items (BMJ Q&S 2020).

Initial validation. One or more SIGNS criteria were present in 48 of the cohort of 50 children who died and had complete records in the office of the Ontario Coroner. SIGNS were present in half of children for more than 24-hours. (BMJ Q&S 2020 under review)

Optimizing the usability and understandability of the SIGNS for Kids tool for its end-users before clinical validation.

Founded on collaborations with the Healthcare Insurance Reciprocal of Canada HIROC and CPSI, this national research program, the goal of this work about timely escalation of care for children with severe illness.

Future Projects
Evaluating the Validity of SIGNS for Kids tool.
Program development for implementation and concurrent evaluation.