NEWS2 Calculator (National Early Warning Score 2)

The UK standard for assessing and responding to acute illness in adult patients. Used throughout the NHS to detect clinical deterioration.

Important Disclaimer: This calculator is for informational purposes only and should be used by qualified healthcare professionals. Clinical judgement should always take precedence over NEWS2 scores. Always follow your local escalation protocols and guidance.
Patient Parameters
Use for patients without hypercapnic respiratory failure
Use for patients with confirmed hypercapnic respiratory failure (e.g., COPD)
About NEWS2

The National Early Warning Score 2 (NEWS2) is the latest version of the National Early Warning Score (NEWS), first produced in 2012 and updated in 2017. It has been endorsed by NHS England and NHS Improvement as the standardised system for assessing acute illness severity in the NHS.

NEWS2 has been designed to:

  • Identify patients at risk of clinical deterioration
  • Standardise the assessment and response to critical illness
  • Improve patient safety and outcomes
  • Reduce variations in care

Key improvements in NEWS2 over the original NEWS include:

  • New SpO₂ Scale 2 for patients with hypercapnic respiratory failure
  • Better recognition of the importance of new-onset confusion or delirium
  • Focus on sepsis identification and response
Note: This calculator is for guidance only. Clinical judgement should always be used alongside NEWS2 scores.

NEWS2 Score Thresholds and Triggers

NEWS2 Score Clinical Risk Monitoring Frequency Clinical Response
0 Low Minimum 12 hourly
  • Continue routine NEWS2 monitoring
Total 1-4 Low Minimum 4-6 hourly
  • Inform registered nurse, who must assess the patient
  • Registered nurse decides if increased frequency of monitoring and/or escalation of care is required
Total 5-6 OR
Score of 3 in any parameter		 Medium Minimum 1 hourly
  • Registered nurse to urgently inform the medical team caring for the patient
  • Urgent assessment by a clinician with core competencies to assess acutely ill patients
  • Clinical care in an environment with monitoring facilities
Total 7 or more High Continuous monitoring
  • Registered nurse to immediately inform the medical team caring for the patient – this should be at least at specialist registrar level
  • Emergency assessment by a clinical team with critical care competencies, including practitioner(s) with advanced airway management skills
  • Consider transfer of care to a level 2 or 3 care facility (e.g., HDU or ICU)

Special Considerations

Hypercapnic Respiratory Failure

Patients with hypercapnic respiratory failure (often due to COPD) typically have chronically elevated carbon dioxide levels and require a different oxygen saturation target range.

Key points:

  • Use Scale 2 for oxygen saturation in these patients
  • Target saturation should typically be 88-92%
  • Saturations above 94-98% may be harmful in hypercapnic respiratory failure
  • Document target range clearly in patient notes/charts

Scale 2 should only be used for patients with confirmed hypercapnic respiratory failure on blood gas analysis. When in doubt, use Scale 1.

ACVPU Assessment

NEWS2 uses ACVPU for assessing consciousness level:

  • A: Alert
  • C: New Confusion or Delirium
  • V: Responds to Verbal stimulus
  • P: Responds to Pain
  • U: Unresponsive

Important notes:

  • New confusion/delirium scores 3 (same as V, P, or U)
  • Any new confusion should trigger an assessment for delirium and potential sepsis
  • For patients with chronic confusion, only new or worsening confusion would score 3

FAQs about NEWS2

NEWS2 should be used in:

  • All adult patients (≥16 years) in acute hospital settings
  • Prehospital settings (paramedic and ambulance services)
  • Mental health hospitals (for patients with physical health problems)
  • Clinical areas where patients are at risk of acute deterioration

NEWS2 is not designed for:

  • Children (under 16 years) - use PEWS instead
  • Pregnant women - use MEOWS/MEWS instead
  • Patients in end-of-life care (though can still be used to monitor symptoms)

NEWS2 can help identify sepsis in several ways:

  • A NEWS2 score of 5 or more is often the first indication of clinical deterioration and should trigger a sepsis screening
  • NEWS2 includes the key vital signs that become abnormal in sepsis (temperature, heart rate, respiratory rate, BP, oxygen saturation, consciousness)
  • Tracking NEWS2 scores over time can show the trajectory of deterioration that suggests sepsis
  • The emphasis on new confusion in NEWS2 helps identify sepsis in elderly patients, where confusion may be the primary presentation

According to the UK Sepsis Trust and NHS England, a NEWS2 score of 5 or more alongside a suspected infection should trigger the Sepsis Six pathway.

The frequency of NEWS2 monitoring should be based on the patient's score:

  • Score 0: At least every 12 hours
  • Score 1-4: At least every 4-6 hours
  • Score 5-6 or 3 in any one parameter: At least hourly
  • Score 7 or more: Continuous monitoring

Monitoring frequency should be increased if there is clinical concern regardless of the score. Local policies may specify more frequent monitoring requirements.

For patients on supplemental oxygen, NEWS2 should be recalculated after any change in oxygen therapy, after an appropriate interval.

While NEWS2 is a valuable tool, it has several limitations:

  • May not detect deterioration in certain conditions where vital signs change minimally (e.g., some neurological conditions)
  • Does not account for patient's baseline abnormalities (e.g., chronic hypertension, tachycardia)
  • Not validated for children or pregnant women
  • May overestimate risk in patients with chronic abnormal vital signs
  • May not reflect pain, distress, or anxiety which can affect vital signs
  • Cannot replace clinical judgement - some patients may be deteriorating despite a low score

NEWS2 should always be used alongside clinical assessment and judgement, and never in isolation to make clinical decisions.

References

  1. Royal College of Physicians. (2017). National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS.
  2. NHS England. (2019). Sepsis guidance implementation advice for adults.
  3. NICE. (2016). Sepsis: recognition, diagnosis and early management (NG51).
  4. Williams, B. et al. (2012). National Early Warning Score (NEWS): Standardising the assessment of acute-illness severity in the NHS. Clinical Medicine, 12(6), 501-503.