When a doctor says that a patient looks sick, he or she means that the patient’s appearance is worrisome for the danger of serious life-threatening deterioration due to the patient’s illness.
Sometimes the patient’s unstable condition is obvious. But often it is not.
The key to decreasing patient mortality is to quickly recognize seriously ill or potentially seriously ill patients as soon as possible.
The National Early Warning Score is a way to recognize serious illness early.
We’ll start with NEWS2 because it is recommended by the National Health Service (UK) to be used instead of NEWS.
So All that follows is from MDCalc on NEWS2
When to Use:
- Patients ≥16 years old.
- Do not use in children <16 years old or pregnant patients.
The Royal College of Physicians recommends [using] 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.
- 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.
Respiratory rate, breaths per minute
SpO2 (on room air or supplemental)
SpO2 (if patient has hypercapnic respiratory failure)*
*Please see Respiratory Failure from Medscape
88-92%, ≥93% on room air
93-94% on supplemental oxygen
95-96% on supplemental oxygen
≥97% on supplemental oxygen
Room air or supplemental oxygen
Systolic BP, mmHg
Pulse, beats per minute
New-onset confusion (or disorientation/agitation), responds to voice, responds to pain, or unresponsive
Facts and Figures For NEWS2
Frequency of monitoring
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
Minimum every hr
Urgent review by a ward-based doctor, to decide change in frequency of clinical monitoring or escalation of care
Urgent review by a ward-based doctor or acute team nurse, to decide if critical care team assessment is needed
Continuous monitoring of vital signs
Emergent assessment by a clinical team or critical care team and usually transfer to higher level of care
All that follows is from MDCAlc on NEWS:
National Early Warning System – Determines the degree of illness of a patient and prompts critical care intervention.
When to Use:
- The NEWS can be used on all hospitalized patients to allow for the early detection of clinical deterioration and potential need for higher level of care.
- The National Early Warning Score (NEWS) was developed to standardize the approach to detection of clinical deterioration in acutely ill patients in the United Kingdom.
- This new standard has still not been fully embraced by the medical community in the UK or elsewhere.
- It is hoped that adopting a single early warning score system will facilitate and standardize training in their use.
- NEWS should not be used in patients under 16 years of age, and pregnant women.
- The physiological parameters of the NEWS score were derived from existing early warning systems and agreed on by members of the NEWSDIG group.
- The NEWS was retrospectively validated against other EWS and found to be more sensitive than most earlier scores. This validation has not yet been published.
- Patients with low NEWS can continue receiving their usual care and observation.
- Patients with high NEWS should be watched more attentively and considered for transfer to a higher care unit such as an ICU.
Criteria Point Value Respiratory Rate (breaths per minute) ≤8 +3 9-11 +1 12-20 0 21-24 +2 ≥25 +3 Oxygen Saturation (%) ≤91 +3 92-93 +2 94-95 +1 ≥96 0 Any Supplemental Oxygen Yes +1 No 0 Temperature in °C (°F) ≤35.0 (95) +3 35.1-36.0 (95.1-96.8) +1 36.1-38.0 (96.9-100.4) 0 38.1-39.0 (100.5-102.2) +1 ≥39.1 (≥102.3) +2 Systolic BP ≤90 +3 91-100 +2 101-110 +1 111-219 0 ≥220 +3 Heart Rate (beats per minute) ≤40 +3 41-50 +1 51-90 0 91-110 +1 111-130 +2 ≥131 +3 AVPU A 0 V, P, or U +3
- A low score (NEWS 1–4) should prompt assessment by a competent registered nurse who should decide if a change to frequency of clinical monitoring or an escalation of clinical care is required.
- A medium score (ie NEWS of 5–6 or a RED score) should prompt an urgent review by a clinician skilled with competencies in the assessment of acute illness – usually a ward-based doctor or acute team nurse, who should consider whether escalation of care to a team with critical-care skills is required (ie critical care outreach team).
- A RED score refers to an extreme variation in a single physiological parameter (i.e., a score of 3 on the NEWS chart in any one physiological parameter, colored RED to aid identification; e.g., heart rate
- A high score (NEWS ≥7) should prompt emergency assessment by a clinical team/critical care outreach team with critical-care competencies and usually transfer of the patient to a higher dependency care area.
Note to myself and occasional readers: After reviewing the above, go ahead and review the resources below.
(1) Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Emerg Med J. 2019 May;36(5):287-292
(2) Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England [PubMed Abstract] [Full Text HTML] [Full Text PDF]. BMJ Open. 2018 Oct 27;8(10):e022528.
(3) The National Early Warning Score 2 (NEWS2) in patients with hypercapnic respiratory failure [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Clin Med (Lond). 2019 Jan;19(1):94-95. doi: 10.7861/clinmedicine.19-1-94.
(5) A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Resuscitation. 2019 Jan;134:147-156. doi: 10.1016/j.resuscitation.2018.09.026. Epub 2018 Oct 1.