NEWS2 Should Not Be Used in Pediatric Patients
The National Early Warning Score 2 (NEWS2) is specifically designed and validated for adult patients only and should not be applied to pediatric populations. Instead, use Pediatric Early Warning Systems (PEWS) for children under 18 years of age.
Why NEWS2 Is Not Appropriate for Pediatrics
Age-Specific Design and Validation
NEWS2 was developed and validated exclusively in adult populations for risk stratification of severe illness and death from sepsis in acute hospital, mental health, and ambulance settings 1
The 2024 NICE guidelines explicitly recommend NEWS2 for calculating risk scores "to determine an adult's risk of severe illness or death from sepsis" 1
The physiological parameters in NEWS2 (respiratory rate thresholds, blood pressure cutoffs, oxygen saturation targets) are calibrated to adult normal ranges and do not account for age-dependent variations in pediatric vital signs 2
Pediatric-Specific Alternatives Exist
The American Heart Association recommends Pediatric Early Warning Systems (PEWS) specifically for children, noting that "the use of EWSS may be considered for adults and children" as separate systems 1
PEWS has been developed with age-appropriate physiological parameters and thresholds that reflect normal pediatric vital sign ranges, which differ substantially from adults 1
Evidence for pediatric early warning systems, while observational and somewhat contradictory, demonstrates that PEWS use was associated with reduction in cardiac arrest rates when used in hospitals with established Medical Emergency Team systems 1
The Critical Age Distinction
Clear Guideline Boundaries
Pediatric scoring rules should be used for all patients under 18 years of age, though clinicians may choose to use adult criteria for adolescents ≥13 years 1
This age cutoff reflects fundamental differences in respiratory, cardiovascular, and neurological physiology between children and adults 1
Studies comparing pediatric versus adult scoring rules in adolescents aged 13-18 years show significantly different results, with more children diagnosed with conditions when pediatric rules are applied 1
Exception: Adults in Children's Hospitals
NEWS2 can and should be implemented for adult patients (age ≥21 years) who are admitted to children's hospitals, particularly those with childhood-onset chronic illnesses 3
A quality improvement study demonstrated successful implementation of NEWS2 for patients age 21 and older at a children's hospital, achieving 90% documentation compliance within 15 weeks, with NEWS value distribution comparable to adult hospitals 3
This represents the only appropriate pediatric setting for NEWS2 use—when the patient is chronologically an adult despite being in a pediatric facility 3
Common Pitfalls to Avoid
Do not attempt to "adjust" NEWS2 for pediatric use—the scoring system's thresholds are fundamentally incompatible with pediatric physiology and cannot be reliably modified 2
Do not rely on NEWS2 in adolescents simply because they appear "adult-sized"—physiological parameters remain age-dependent regardless of body habitus 1
Avoid mixing scoring systems—if using PEWS for general pediatric patients, continue using PEWS rather than switching to NEWS2 at an arbitrary age cutoff below 18 years 4
Practical Algorithm for Score Selection
Step 1: Determine patient age
- Age <13 years → Use PEWS exclusively 1
- Age 13-17 years → Use PEWS (preferred) or adult criteria (clinician discretion) 1
- Age ≥18 years → Use NEWS2 1, 2
Step 2: Consider clinical setting
- Pediatric hospital with adult patient (≥21 years) → Implement NEWS2 3
- Adult hospital with adolescent patient → May use adult criteria for ages ≥13 years 1
Step 3: Apply appropriate monitoring intervals based on chosen system