About

The National Early Warning Score 2 (NEWS2) is a standardized system used by healthcare professionals to assess acute illness severity in adult patients. Unlike subjective assessments, this algorithmic approach quantifies physiological instability to trigger specific clinical responses. It serves as a universal language for patient deterioration across acute care settings, from emergency departments to general wards.

Accuracy in this calculation is non-negotiable. A miscalculation of a single point can alter the recommended escalation pathway, potentially delaying critical interventions or overburdening rapid response teams. This tool adheres strictly to the Royal College of Physicians (2017) specifications, including the distinct SpO2 scales for patients with hypercapnic respiratory failure.

Formulas

The total score is the summation of seven physiological parameters, each weighted from 0 to 3 based on deviation from the norm.

Score = 7∑i=1 weight(parameter_i)

Where parameters include Respiration Rate, Oxygen Saturation (Scale 1 or 2), Air or Oxygen Supplement, Systolic Blood Pressure, Pulse, Consciousness Level, and Temperature. The SpO2 weighting depends on the clinical context (hypercapnic failure risk).

Reference Data

Score Range	Clinical Risk	Response Frequency	Ward-Based Response
0	Low	Min 12 hourly	Competent registered nurse assessment.
1 − 4	Low	Min 4-6 hourly	Registered nurse assessment. Decide if frequency increase required.
3 (Single Parameter)	Low-Medium	Min 1 hourly	Urgent review by clinician with core competencies.
5 − 6	Medium	Min 1 hourly	Urgent review by clinician with critical care competencies.
7 +	High	Continuous	Emergency assessment by clinical team with critical care competencies (usually including airway skills). Transfer to critical care often required.
Ref	Sepsis Risk	Immediate	If score ≥ 5, screen immediately for Sepsis (Red Flag Sepsis).

Frequently Asked Questions

Scale 2 is exclusively for patients with a prescribed oxygen saturation requirement of 88-92%, such as those with hypercapnic respiratory failure (e.g., COPD). Using Scale 1 for these patients may result in artificially high scores due to their baseline lower saturation.

Yes. A score of 3 in any single individual parameter (Red Score) implies a significant physiological deviation that warrants an urgent review, even if the aggregate total score remains low (e.g., Total Score 4).

No. NEWS2 is validated for adults (aged 16 or over). It is not designed for use in children (PEWS), pregnant women (MEOWS), or patients with spinal cord injuries where autonomic dysreflexia may affect vitals.

It uses the ACVPU scale. "Alert" scores 0. New confusion (C), responding to Voice (V), Pain (P), or Unresponsive (U) all score 3. Note that "Confusion" was a key addition in the 2017 update.