National Early Warning Score 2 (NEWS2): Purpose and Application in Clinical Settings
The National Early Warning Score 2 (NEWS2) is a standardized tool designed to stratify the risk of mortality and clinical deterioration in adult patients, with scores determining monitoring frequency and intervention urgency across acute hospital, mental health, and ambulance settings. 1, 2
Core Components and Scoring System
NEWS2 evaluates six physiological parameters:
- Respiratory rate
- Oxygen saturation (with two scales: standard and adjusted for hypercapnic respiratory failure)
- Supplemental oxygen use
- Systolic blood pressure
- Heart rate
- Level of consciousness (using CVPU: Confusion, Voice, Pain, Unresponsive)
- Temperature
Each parameter is scored 0-3 points, with the total score determining risk level:
- 0 points: Very low risk
- 1-4 points: Low risk
- 5-6 points: Moderate risk
- ≥7 points: High risk
A score of 3 in any single parameter may indicate increased risk from sepsis and requires special attention. 1, 2
Clinical Application and Monitoring Protocol
The NEWS2 score directly determines monitoring frequency and clinical response:
- High risk (≥7): Monitor every 30 minutes; evaluation by experienced physician; antibiotics within 1 hour if sepsis suspected
- Moderate risk (5-6): Monitor every hour; antibiotics within 3 hours if sepsis suspected
- Low risk (1-4): Monitor every 4-6 hours; antibiotics within 6 hours if sepsis suspected
- Very low risk (0): Follow standard protocol 1, 2
Evidence for Effectiveness
Recent research demonstrates NEWS2's value in predicting outcomes. A 2025 study showed significant differences in NEWS2 scores between survivors (mean 4.36) and non-survivors (mean 13.14), confirming its effectiveness in identifying patients at risk of deterioration. 3
Special Considerations and Limitations
NEWS2 should be interpreted in context of the patient's underlying physiology and comorbidities
Consider higher risk regardless of NEWS2 score if patients present with:
Re-evaluate risk if:
- Condition is deteriorating
- No improvement since previous assessment
- After any interventions 1
Implementation Challenges
While NEWS2 has demonstrated value, implementation challenges exist:
- At the recommended threshold of ≥5, sensitivity for predicting deterioration is approximately 0.46, with a number needed to evaluate of 52 4
- This threshold generates approximately 37.6 alerts per 100 patient-days, potentially creating resource allocation challenges 4
Practical Application Beyond Hospital Settings
NEWS2 has expanded beyond hospitals to community settings, providing a common language across healthcare environments. This standardization helps ensure consistent assessment and communication of deterioration risk, particularly valuable in ambulance services and emergency departments. 5
COVID-19 Application
During the COVID-19 pandemic, NEWS2 proved valuable for triage and monitoring, performing comparably or superiorly to other scoring systems like qSOFA and CURB-65. A NEWS2 score of 5 demonstrated high sensitivity for detecting patients likely to deteriorate, though with moderate specificity. 6