emergency & critical carescoring tool

NEWS2 (National Early Warning Score 2)

NEWS2 is the NHS standard early warning scoring system for detecting and responding to clinical deterioration in acutely ill patients. It scores 7 physiological parameters routinely measured in hospitals: respiratory rate, oxygen saturation, supplemental oxygen, temperature, systolic blood pressure, heart rate, and level of consciousness.

inputs

breaths/min
%
mmHg
bpm
C = new-onset confusion, disorientation, or agitation

✓ when to use

Use for all adult patients in acute hospital settings (ED, wards, assessment units) and increasingly in pre-hospital, primary care, and community settings. NEWS2 is endorsed by NHS England as the standard early warning system across the NHS. It should be recorded at every routine observation round and whenever clinical concern arises. A NEWS2 of 5+ should prompt 'Think Sepsis' assessment.

✗ when not to use

NEWS2 is designed for adults ≥16 years. Not validated in children (use PEWS). Parameters may be unreliable in pregnancy (physiological tachycardia, lower BP), chronic conditions with altered baselines (e.g., patients with spinal cord injury may have chronic low BP), and post-operative patients (expected physiological changes). NEWS2 should supplement, not replace, clinical judgement — a clinically concerning patient should be escalated regardless of NEWS2 score.

clinical pearls

  • A score of 5 is the key threshold — it triggers urgent clinical review and should prompt the question 'Could this be sepsis?' in any patient with known or suspected infection. This is the most important number in NEWS2.
  • A single parameter score of 3 triggers urgent review REGARDLESS of total NEWS2. A patient with NEWS2 of 3 but a respiratory rate of 8 (scores 3) needs urgent assessment just as much as a patient with NEWS2 of 5.
  • SpO₂ Scale 2 is ONLY for patients with confirmed hypercapnic respiratory failure (typically certain COPD patients with documented CO₂ retention on blood gas). It must be a specific clinical decision by an authorised prescriber. Do NOT use Scale 2 for all COPD patients — most AECOPD patients should be assessed on Scale 1 initially.
  • NEWS2 score of 0 does not mean the patient is well. It means their physiological parameters are within the normal scoring range at this moment. Clinical concern should always override the score.
  • An unchanging NEWS2 score with increasing oxygen requirements represents deterioration — this is particularly important in pneumonia and COVID-19. The binary oxygen supplementation score (0 or 2) can mask progressive respiratory failure if the patient is being escalated through increasing FiO₂.

related tools

qsofaSepsis-focused screeninggcsDetailed consciousness assessmentsofaOrgan dysfunction assessment in ICU