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    Patent Pending

    National Early Warning Score (NEWS) 2

    Determines the degree of illness of a patient and prompts critical care intervention (recommended by NHS over original NEWS).
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    INSTRUCTIONS

    Recommended by the NHS (UK) over the original NEWS.

    When to Use
    Pearls/Pitfalls

    • 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.

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

    ≤8
    +3
    9-11
    +1
    12-20
    0
    21-24
    +2
    ≥25
    +3
    No
    Yes
    Supplemental O₂
    +2
    Room air
    0
    ≤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
    ≤90
    +3
    91-100
    +2
    101-110
    +1
    111-219
    0
    ≥220
    +3
    ≤40
    +3
    41-50
    +1
    51-90
    0
    91-110
    +1
    111-130
    +2
    ≥131
    +3
    Alert
    0
    New-onset confusion (or disorientation/agitation), responds to voice, responds to pain, or unresponsive
    +3

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    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.

    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(on room air or supplemental

    ≤91%

    3

    92-93%

    2

    94-95%

    1

    ≥96%

    0

    SpO2 (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


    Facts & Figures

    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


    Dr. Gary B. Smith

    About the Creator

    Gary B. Smith, Cert Med, FRCA, FRCP, is a visiting professor at the School of Health & Social Care, University of Bournemouth, UK. He is director of the UK Deteriorating Hospital Patient conference and co-director of the International Conferences on Rapid Response Systems. Professor Smith co-developed RSVP (Reason-Story-Vital Signs-Plan), for communicating patient deterioration and the Chain of Prevention, a paradigm for preventing patient deterioration.

    To view Dr. Gary B. Smith's publications, visit PubMed

    About the Creator
    Dr. Gary B. Smith