Acute Medicine
NEWS2 (National Early Warning Score 2)
Standardised UK early-warning score for acute illness.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The National Early Warning Score 2 (NEWS2) is a standardised system for detecting and responding to acute clinical deterioration in adults, mandated across UK practice. It aggregates points from six physiological parameters — respiratory rate, oxygen saturation, supplemental oxygen, systolic blood pressure, pulse and level of consciousness — plus temperature, giving a single total. New confusion is scored within the consciousness parameter, and supplemental oxygen and an SpO₂ scale for hypercapnic patients were added in the 2017 update. The aggregate score triggers a graded clinical response.
Interpreting the result
An aggregate score of 0–4 is low and prompts a ward-based response, 5–6 is medium and triggers an urgent review, and 7 or more is high and triggers an emergency, critical-care-level response. A score of 3 in any single parameter also warrants an urgent review even when the aggregate is otherwise low. The score guides, but does not replace, clinical judgement and the local escalation policy.
Advice
Aggregate 5–6 (or 3 in any single parameter) triggers an urgent review; ≥7 triggers an emergency response. Always follow your local NEWS2 escalation policy.
Worked example
A patient with a respiratory rate of 26/min (3), SpO₂ of 93% on air (2) and new confusion (3) scores 8. This high score triggers an emergency response with urgent senior and critical-care assessment under the local protocol.
Critical actions
Use SpO₂ scale 2 only for patients with target range 88–92% (e.g. hypercapnic respiratory failure) — this tool uses scale 1.
Pearls / pitfalls
- Use SpO₂ scale 2 only for patients with a target range of 88–92% (such as those with hypercapnic respiratory failure); the standard tool uses scale 1.
- NEWS2 is not validated for pregnant women, children, or some specific patient groups — use the appropriate dedicated tool instead.
- A single parameter scoring 3 mandates review even if the total is otherwise reassuring.
- The score supports escalation decisions but must always be combined with clinical judgement and the local response policy.
Evidence & validation
NEWS2 was developed and endorsed by the Royal College of Physicians and is recommended for use throughout UK practice to standardise the recognition of and response to acute deterioration in adults.
Frequently asked questions
What NEWS2 score triggers escalation?
An aggregate of 5–6 (or 3 in any single parameter) triggers an urgent review, and 7 or more triggers an emergency, critical-care-level response. Always follow your local escalation policy.
When should SpO₂ scale 2 be used?
Scale 2 is for patients with a prescribed target saturation of 88–92%, typically those at risk of hypercapnic respiratory failure. Otherwise scale 1 is used.
Can NEWS2 be used in pregnancy?
No. NEWS2 is not validated for pregnant women; a dedicated obstetric early-warning score should be used instead.
Does a low NEWS2 mean the patient is safe?
A low score is reassuring but does not override clinical concern. If a clinician is worried, escalation is appropriate regardless of the aggregate score.
Why does supplemental oxygen add points?
Needing supplemental oxygen indicates a sicker patient, so it adds to the score. This was one of the key refinements introduced in NEWS2.
References
- Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in UK practice. London: RCP, 2017.
- UK health service England. National Early Warning Score (NEWS2) deployment guidance.
About the creator
Royal College of Physicians
Related calculators
Need a calculator we don't have — or a custom tool?
We build evidence-led clinical calculators, dashboards and reference tools for teams.