What is the NEWS2 score?

NEWS2 (National Early Warning Score 2) is a standardized system for assessing and responding to acute illness in hospitalized patients. It scores six physiological parameters: respiratory rate, SpO₂, systolic blood pressure, pulse rate, consciousness level, and temperature, plus supplemental oxygen use.

How is NEWS2 interpreted?

Score 0: No risk. Score 1–4: Low risk, minimum 12-hourly monitoring. Score 5–6 or 3 in any single parameter: Medium risk, increase monitoring to at least hourly, urgent clinical review. Score ≥ 7: High risk, continuous monitoring, emergent clinical review, consider ICU transfer.

What is new in NEWS2 compared to the original NEWS?

NEWS2 added a specific SpO₂ scale for patients with hypercapnic respiratory failure (e.g., COPD) who have a target SpO₂ of 88–92%, plus a new consciousness assessment including "new confusion" as an alerting sign (using ACVPU instead of AVPU).

NEWS2 is the standard early warning score recommended by the Royal College of Physicians and adopted across the NHS in the United Kingdom. It is increasingly used internationally. It is designed for adult patients in acute and ambulance settings, not for children (who use PEWS) or obstetric patients.

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NEWS2 Score Calculator

National Early Warning Score 2 — standardized assessment of acute illness severity in hospitalized patients.

Parameters

Respiratory Rate (breaths/min)

SpO₂ (%)

SpO₂ Scale

Air or Oxygen?

Systolic BP (mmHg)

Heart Rate (bpm)

Consciousness (AVPU)

Temperature (°C)

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Enter all parameters to calculate NEWS2.

0 (aggregate)Low risk — routine monitoring

1–4 (low)Ward-based response

3 in any parameterUrgent ward-based response

5–6 (medium)Key threshold for urgent response

≥7 (high)Emergency response — critical care assessment

Disclaimer: For educational purposes only. Not a substitute for clinical judgment.

When to use

NEWS2 is used for standardized assessment of acute illness severity in hospitalized adults. It was developed by the Royal College of Physicians (UK) and is mandated in NHS hospitals.

Clinical pearls

Use Scale 2 for patients with confirmed hypercapnic respiratory failure (e.g., COPD with target SpO₂ 88–92%).
A score of 3 in any single parameter should trigger an urgent clinical assessment.
NEWS2 ≥5 is the key threshold for urgent response and clinical review.

References

Royal College of Physicians. National Early Warning Score (NEWS) 2. 2017.

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About This Tool

What Is NEWS2?

The National Early Warning Score 2 (NEWS2) is a standardized clinical assessment tool developed by the Royal College of Physicians in 2012 and updated in 2017. It is designed to detect acute deterioration in hospitalized adult patients by aggregating scores from six physiological parameters: respiratory rate, oxygen saturation, systolic blood pressure, heart rate, level of consciousness, and temperature, plus whether the patient is on supplemental oxygen. Scores range from 0 to 20, with higher scores indicating greater clinical severity and urgency of response.

Scale 1 vs. Scale 2

NEWS2 introduced a dual SpO₂ scoring system. Scale 1 is used for most patients and assigns points for low oxygen saturations. Scale 2 is specifically designed for patients with confirmed hypercapnic respiratory failure (typically COPD patients) who have a target SpO₂ range of 88–92%. In Scale 2, points are also assigned for saturations that are too high (≥97% on supplemental oxygen), recognizing that over-oxygenation in these patients can suppress respiratory drive and worsen hypercapnia.

Clinical Response Framework

NEWS2 drives a structured escalation framework: a score of 0 indicates low risk with routine monitoring, 1–4 suggests low risk but requires assessment by a competent nurse, a score of 3 in any single parameter triggers an urgent ward-based response, 5–6 indicates medium risk requiring urgent clinical review, and ≥7 indicates high risk requiring emergency response with critical care team assessment. This standardized approach has been shown to reduce cardiac arrests, unplanned ICU admissions, and hospital mortality in multiple studies.

🔑 Clinical Pearls

NEWS2 is mandated in all NHS acute trusts in England — it is the national standard for deterioration detection.
The addition of "new confusion" as an AVPU category was a key change in NEWS2 (vs. original NEWS).
NEWS2 is validated for adults only — pediatric patients should use PEWS (Pediatric Early Warning Score).
Combine NEWS2 with clinical judgment — patients can deteriorate rapidly with initially low scores.

Key References

Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the Assessment of Acute-Illness Severity in the NHS. London: RCP, 2017.
Smith GB, et al. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84(4):465-470.

Formula last verified: February 2026