NEWS2 is one of those things you are expected to already understand by the time anyone explains it to you. It appears on the handover sheet, the receiving could nurse ask for it, and somewhere in the middle of a job you are quietly adding up numbers in your head (unless it’s integrated onto your PCR system). It is worth knowing properly, because a score you do not understand fully, might not be so helpful.
What it is measuring
NEWS2 is an aggregate weighted score built from seven rows on the chart. Each is scored 0 to 3, and the total is what gets escalated.
- Respiratory rate — the parameter most often guessed and least often counted. Count it properly for a full minute if anything about it looks unusual.
- Oxygen saturation — using Scale 1 for most patients, or Scale 2 for the group of patients with hypercapnic respiratory failure / documented target range.
- Air or supplemental oxygen — a separate row worth 2 points on its own. Being on oxygen is itself a warning sign (although for some patients, this is their baseline).
- Systolic blood pressure
- Pulse
- Consciousness — scored using ACVPU. The C is for new confusion/worsening confusion, and it scores 3, the same as being unresponsive.
- Temperature
What the total means
The score is a trigger for a response, not a diagnosis. Broadly speaking (not an exhaustive example): a total of 0 to 4 sits in the low range, 5 or 6 calls for an urgent response, and 7 or more is the high band. Separately, any single parameter scoring 3 matters on its own even when the total is low.
Your trust will have its own thresholds for what each band triggers prehospitally, and those are the ones that count. Learn them rather than the generic version.
The bits students get wrong
Forgetting the oxygen row. A patient on 4 litres with saturations of 96% is not the same as a patient on air with saturations of 96%, and the score is designed to say so.
Reaching for Scale 2 in anyone with COPD. Scale 2 is for patients with confirmed hypercapnic respiratory failure / prescribed target range, not for everyone with COPD. Defaulting to it hides deterioration.
Scoring new confusion as A. Alert and confused are not the same thing. If the family say this is not how they normally are, consider it as a C.
Treating one score as the answer. A single number is a snapshot. Two sets twenty minutes apart tell you the direction of travel, which is the part that actually changes decisions.
What it does not do
NEWS2 was designed for tracking acutely unwell adults, and it is not validated for children, for pregnancy, or as a triage tool for deciding who is unwell in the first place. It also does not override you. A low score on a patient who worries you is a reason to be concerned. It does not replace sound clinical judgement.
If you want a guide on asking questions, our Review of Systems Questions Tool covers the questions to ask alongside the numbers you record.