National Early Warning Score (NEWS) 2

NEWS2 Calculator
Respiration Rate (breaths/min)
SpO₂ Scale
SpO₂ Scale 1 (%)
SpO₂ Scale 2 (%) - COPD
Air or Oxygen
Systolic Blood Pressure (mmHg)
Pulse (beats/min)
Consciousness
Temperature (°C)
NEWS2 Score: –
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Determines the degree of illness of a patient and prompts critical care intervention (recommended by NHS over original NEWS).

When to Use

Patients ≥16 years old. Do not use in children <16 years old or pregnant patients. The Royal College of Physicians recommends the NEWS2 in the following settings: Emergency: for initial assessment, serial monitoring, and assessment for triage. Ward: for initial inpatient assessment and serial monitoring. Prehospital: for communication of illness severity to receiving hospitals.

Formula

Addition of the selected points: Variable Points Respiratory rate, breaths per minute ≤8 3 9-11 1 12-20 0 21-24 2 ≥25 3 SpO 2 (on room air or supplemental) ≤91% 3 92-93% 2 94-95% 1 ≥96% 0 SpO 2 (if patient has hypercapnic respiratory failure) ≤83% 3 84-85% 2 86-87% 1 88-92%, ≥93% on room air 0 93-94% on supplemental oxygen 1 95-96% on supplemental oxygen 2 ≥97% on supplemental oxygen 3 Room air or supplemental oxygen Supplemental oxygen 2 Room air 0 Temperature ≤35.0°C (95°F) 3 35.1-36.0°C (95.1-96.8°F) 1 36.1-38.0°C (96.9-100.4°F) 0 38.1-39.0°C (100.5-102.2°F) 1 ≥39.1°C (102.3°F) 2 Systolic BP, mmHg ≤90 3 91-100 2 101-110 1 111-219 0 ≥220 3 Pulse, beats per minute ≤40 3 41-50 1 51-90 0 91-110 1 111-130 2 ≥131 3 Consciousness Alert 0 New-onset confusion (or disorientation/agitation), responds to voice, responds to pain, or unresponsive 3

Pearls / Pitfalls

May not be reliable in patients with spinal cord injury due to functional disturbance of autonomic responses.

Advice

The NEWS2 (and any early warning score) should be used as an adjunct to clinical judgment, not to replace it. Any concern about a patient’s clinical condition should prompt urgent investigation regardless of early warning scores.

More Information

Interpretation: NEW Score Clinical risk Frequency of monitoring Response 0-4 Low Minimum every 12 hrs if score of 0 Minimum every 4-6 hrs if score 1-4 Assessment by a competent registered nurse or equivalent, to decide change in frequency of clinical monitoring or escalation of care Score of 3 in any individual parameter Low-medium Minimum every hr Urgent review by a ward-based doctor, to decide change in frequency of clinical monitoring or escalation of care 5-6 Medium Urgent review by a ward-based doctor or acute team nurse, to decide if critical care team assessment is needed ≥7 High Continuous monitoring of vital signs Emergent assessment by a clinical team or critical care team and usually transfer to higher level of care

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