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 NEWS2 is an updated version.
Patient selection: hospital inpatient adult
Changes with NEWS2:
(1) addition of new confusion as a scored item.
(2) addition of oxygen saturation scoring for hypercapnic respiratory failure
(3) using a score >= 5 to identify urgency
(4) emphasizing use in early detection of sepsis
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 by AVPU or new confusion C
(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 |
|
CNS status |
alert |
0 |
|
|
new or worsening confusion |
3 |
|
|
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 |
|
oxygen saturation scale 1 for usual patients |
<= 91% |
3 |
|
|
92 to 93% |
2 |
|
|
94 to 95% |
1 |
|
|
>= 96% |
0 |
|
oxygen saturation scale 2 for patient with hypercapnic respiratory failure |
<=83% |
3 |
|
|
84 to 85% |
2 |
|
|
86 to 87% |
1 |
|
|
88 to 92% |
0 |
|
|
>= 93% on air |
0 |
|
|
93 to 94% on oxygen |
1 |
|
|
95 to 96% on oxygen |
2 |
|
|
>= 97% on oxygen |
3 |
NEWS2 score =
= SUM(points for all 7 parameters, using the appropriate oxygen saturation scale)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the more serious the patient's condition.
• A score >= 5 indicates a patient who should have an urgent clinical review.
• A single score of 3 (a red score) is unusual and should prompt an urgent review, usually the ward-based doctor or acute team nurse. The patient should be monitored at a minimum of 1 hour.
|
Score |
30-Day Mortality |
Frequency of Monitoring |
|
0 |
|
minimum 12 hours |
|
1 to 4 |
5.5% |
minimum 4-6 hours |
|
5 or 6 |
11% |
minimum 1 hour |
|
7 or 8 |
13% |
continuous monitoring |
|
>= 9 |
28% |
continuous monitoring |
