NEWS2
National Early Warning Score 2 — detecting clinical deterioration in adults (SpO₂ scale 1)
- Royal College of Physicians 2017
Sources last checked: 2026-10-13
NEWS2
National Early Warning Score 2 — detecting clinical deterioration in adults (SpO₂ scale 1)
Uses SpO₂ scale 1 only. In confirmed hypercapnic respiratory failure with a prescribed target of 88–92 %, use the RCP scale 2 chart instead — scale 1 over-scores these patients. RCP 2017 links a score of 3 in any single parameter to urgent review whatever the total; the total alone does not show this. Not for children or pregnant women.
Interpretation
| 0 — low | RCP 2017 (Chart 4): minimum 12-hourly observations as part of routine NEWS2 monitoring. |
|---|---|
| 1–4 — low | RCP 2017 (Chart 4): minimum 4–6-hourly observations; a registered nurse assesses the patient and decides on monitoring frequency and escalation. A single parameter scoring 3 is a 'red score', for which RCP 2017 specifies minimum hourly observations and urgent review by the medical team. |
| 5–6 — medium (urgent response threshold) | RCP 2017 (Chart 4): minimum hourly observations and urgent assessment by a clinician or team competent in acute illness, in an environment with monitoring facilities. |
| ≥ 7 — high (emergency response threshold) | RCP 2017 (Chart 4): continuous monitoring of vital signs and emergency assessment by a team with critical-care competencies including advanced airway skills; the chart lists transfer to level 2 or 3 care (HDU/ICU) as a consideration. |
What is the NEWS2?
NEWS2 aggregates seven routine observations into a score that flags acute deterioration in adults. It was published by the Royal College of Physicians in 2017 as an update of NEWS (2012) and is the standard track-and-trigger system in the NHS. Thresholds of 5 and 7 trigger urgent and emergency clinical responses.
When to use it
- Adults on hospital wards, in the emergency department or in ambulance services.
- Repeated monitoring to detect a change in trajectory rather than a single snapshot.
- Screening for possible sepsis or deterioration in patients with suspected infection.
When not to use it
- Children and pregnant women — dedicated paediatric and obstetric early-warning scores exist.
- Patients with hypercapnic respiratory failure and a target SpO₂ of 88–92 % unless scale 2 is used.
- End-of-life care where escalation is not part of the plan.
How it is calculated
| Criterion | Points |
|---|---|
| Respiratory rate (/min) | |
| ≤ 8 | 3 |
| 9–11 | 1 |
| 12–20 | 0 |
| 21–24 | 2 |
| ≥ 25 | 3 |
| SpO₂, scale 1 (%) | |
| ≤ 91 | 3 |
| 92–93 | 2 |
| 94–95 | 1 |
| ≥ 96 | 0 |
| Air or oxygen? | |
| Air | 0 |
| Supplemental oxygen | 2 |
| Systolic blood pressure (mmHg) | |
| ≤ 90 | 3 |
| 91–100 | 2 |
| 101–110 | 1 |
| 111–219 | 0 |
| ≥ 220 | 3 |
| Pulse (/min) | |
| ≤ 40 | 3 |
| 41–50 | 1 |
| 51–90 | 0 |
| 91–110 | 1 |
| 111–130 | 2 |
| ≥ 131 | 3 |
| Consciousness | |
| Alert | 0 |
| New confusion, or responds only to voice or pain, or unresponsive (CVPU) | 3 |
| Temperature (°C) | |
| ≤ 35.0 | 3 |
| 35.1–36.0 | 1 |
| 36.1–38.0 | 0 |
| 38.1–39.0 | 1 |
| ≥ 39.1 | 2 |
Clinical pearls and limitations
- Uses SpO₂ scale 1 only. In confirmed hypercapnic respiratory failure with a prescribed target of 88–92 %, use the RCP scale 2 chart instead — scale 1 over-scores these patients. RCP 2017 links a score of 3 in any single parameter to urgent review whatever the total; the total alone does not show this. Not for children or pregnant women.
- Any single parameter scoring 3 is a 'red score', for which RCP 2017 specifies urgent review even if the total is 1–4.
- New confusion scores 3 on its own: CVPU replaces AVPU in NEWS2.
- Supplemental oxygen adds 2 points regardless of saturation.
- SpO₂ scale 2 is reserved for confirmed hypercapnic respiratory failure with a prescribed target of 88–92 %; this calculator does not implement it.
- The German S3 sepsis guideline (2025) lists NEWS/NEWS2 among screening tools with better sensitivity than qSOFA.
Frequently asked questions
What NEWS2 score is concerning?
A total of 5–6 is the urgent-response threshold, ≥ 7 the emergency threshold; RCP 2017 also links a 3 in any single parameter to urgent review.
What changed from NEWS to NEWS2?
NEWS2 added new confusion to the consciousness item (ACVPU) and a second SpO₂ scale for hypercapnic respiratory failure.
Is NEWS2 used in Germany?
It is used in some hospitals and mentioned in the German S3 sepsis guideline as a screening option, but it is not a nationally mandated system as in the NHS.
Does NEWS2 diagnose sepsis?
No. It flags deterioration; sepsis is defined by infection plus organ dysfunction (SOFA rise ≥ 2).
Evidence and guidelines
- Primary source: Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017 (Charts 1, 2 and 4).
- Deutsche Sepsis-Gesellschaft. S3-Leitlinie Sepsis – Prävention, Diagnose, Therapie und Nachsorge, Update 2025 (AWMF-Register 079-001), Definition 1.
Have a follow-up question?
Medelix answers clinical questions from current guidelines and studies — every statement with its source.
Ask Medelix about the NEWS2Related calculators
- qSOFABedside alert for poor outcome in suspected infection
- SOFA scoreSequential (Sepsis-related) Organ Failure Assessment — organ dysfunction for the Sepsis-3 definition
- SIRS criteriaSystemic inflammatory response syndrome (ACCP/SCCM 1992)
- Glasgow Coma ScaleLevel of consciousness
- CRB-65Mortality risk and treatment setting in community-acquired pneumonia — no blood test needed
Embed this calculatorFree to use on your website, intranet or teaching page. Copy the code below.
<iframe src="https://medelix.ai/en/embed/news2" title="NEWS2 – Medelix" width="100%" height="620" style="border:0;max-width:720px" loading="lazy"></iframe>
<p><a href="https://medelix.ai/en/calculators/news2-score">NEWS2 calculator by Medelix</a></p>For healthcare professionals and medical students. These tools support, and do not replace, clinical judgement. Always check results against the original source and your local protocols.