Severe illness getting noticed sooner – SIGNS-for-Kids: developing an illness recognition tool to connect home and hospital

Abstract

BackgroundDelays 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.MethodsA 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.ResultsOne 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.ConclusionsSpecific 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.

Parents' process of recognition and response to clinical deterioration of their children with medical complexity at home: A grounded theory

“…This knowledge often allows them to recognise well in advance when their child is showing signs and symptoms of illness (Rennick et al, 2019; Spratling & Lee, 2020). The warning signs and symptoms of clinical deterioration that prompt parents of children with MC to intervene are common to children with acute conditions (Gaskin et al, 2018; Gilleland et al, 2019; Rudd et al, 2020). However, we found that parents of children with MC with less experience rely primarily on vital signs monitoring while more expert parents are alerted by their child's behaviour and their own intuition to identify evolving clinical deterioration.…”

“…This knowledge often allows them to recognise well in advance when their child is showing signs and symptoms of illness (Rennick et al, 2019;Spratling & Lee, 2020). The warning signs and symptoms of clinical deterioration that prompt parents of children with MC to intervene are common to children with acute conditions (Gaskin et al, 2018;Gilleland et al, 2019;Rudd et al, 2020).…”

Signs and symptoms of serious illness in infants aged up to 6 months: rapid review of clinical guidelines

“…With increased vaccines, better maternity care and societal hygiene, the current health situation has changed considerably in the past three decades. In addition, there is more evidence of the important indicators of severe illness in infants which has been translated into tools such as the PArents’ Trigger Tool for Children with Medical Complexity (PAT-CMC) 10 and the SIGNS-for-Kids illness recognition tool 11 to guide parents, carers and clinicians. Creating resources to empower parents and carers to detect serious illness in young infants therefore necessitates a review of current clinical guidelines.…”

Severe illness getting noticed sooner: SIGNS-for-Kids—initial validity assessment of a paediatric illness recognition tool for caregivers

“…Timely identification of severe illness provides opportunity to prevent clinical deterioration and reduce morbidity and mortality 1–4. An expert panel consisting of parents and multidisciplinary providers created the Severe Illness Getting Noticed Sooner (SIGNS)-for-Kids as a public health tool to help caregivers identify and articulate the manifestations of severe illness in children 5. The tool was created during a consensus development workshop to incorporate expert opinion and previously published symptom checklists of severe illness 6 7.…”