The British National Health Service (NHS) developed a national early warning score (NEWS) in conjunction with a redesigned clinical chart to monitor hospital inpatients. This can help to detect a patient who may be deteriorating much earlier.
The NEWS score resembles several other early warning scores but has different break points and the addition of supplemental oxygen.
Patient selection: hospital inpatient adult
Parameters:
(1) heart rate in beats per minute
(2) systolic blood pressure in mm Hg
(3) respiratory rate in breaths per minute
(4) oxygen saturation in percent
(5) consciousness level
(6) temperature
(7) any supplemental oxygen (must be prescribed)
|
Parameter |
Finding |
Points |
|
heart rate |
<= 40 beats per minute |
3 |
|
|
41 to 50 beats per minute |
1 |
|
|
51 to 90 beats per minute |
0 |
|
|
91 to 110 beats per minute |
1 |
|
|
111 to 130 beats per minute |
2 |
|
|
>= 131 |
3 |
|
systolic blood pressure |
<= 90 mm Hg |
3 |
|
|
91 to 100 mm Hg |
2 |
|
|
101 to 110 mm Hg |
1 |
|
|
111 to 219 mm Hg |
0 |
|
|
>= 220 mm Hg |
3 |
|
respiratory rate |
<= 8 |
3 |
|
|
9 to 11 |
1 |
|
|
12 to 20 |
0 |
|
|
21 to 24 |
2 |
|
|
>= 25 |
3 |
|
oxygen saturation |
<= 91 percent |
3 |
|
|
92 to 93 percent |
2 |
|
|
94 to 95 percent |
1 |
|
|
>= 96 percent |
0 |
|
CNS status |
alert |
0 |
|
|
responds to voice |
3 |
|
|
responds to pain |
3 |
|
|
unresponsive to all stimuli |
3 |
|
temperature |
<= 35°C |
3 |
|
|
35.1 to 36.0°C |
1 |
|
|
36.1 to 38.0°C |
0 |
|
|
38.1 to 39.0°C |
1 |
|
|
>= 39.1°C |
2 |
|
any supplemental oxygen |
no |
0 |
|
|
yes |
2 |
where:
• A patient with COPD-associated hypercapneic respiratory failure should use target saturations of 88 to 92% (see page 14).
• New or worsening confusion is not scored but should prompt a clinical evaluation (page 10).
NEWS score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the more serious the patient's condition.
