Overview
NEWS2 (National Early Warning Score 2) is the updated version of the original NEWS, published by the Royal College of Physicians in 2017. It provides a single standardised method for assessing acute illness severity in adult patients using seven routinely measured physiological parameters.
The score is designed to trigger an escalating clinical response at defined thresholds, from increased monitoring frequency for low scores to immediate emergency team involvement for high scores (≥ 7). A key feature is the "single-parameter rule": a score of 3 in any one parameter automatically triggers a medium-risk response, even if the aggregate total is below 5.
NEWS2 introduced two changes from the 2012 original: a revised ACVPU consciousness scale that includes new confusion as a separate level, and a dual SpO₂ scale system for patients at risk of hypercapnic respiratory failure (e.g. COPD), whose target saturation is 88–92% rather than ≥ 96%.
Scoring Table
| Parameter | 3 | 2 | 1 | 0 | 1 | 2 | 3 |
|---|---|---|---|---|---|---|---|
| Respiration rate (/min) | ≤ 8 | 9–11 | 12–20 | 21–24 | ≥ 25 | ||
| SpO₂ Scale 1 (%) | ≤ 91 | 92–93 | 94–95 | ≥ 96 | |||
| SpO₂ Scale 2 (%) * | ≤ 83 | 84–85 | 86–87 | 88–92 / ≥ 93 on air | 93–94 on O₂ | 95–96 on O₂ | ≥ 97 on O₂ |
| Supplemental O₂ | Yes | No | |||||
| Systolic BP (mmHg) | ≤ 90 | 91–100 | 101–110 | 111–219 | ≥ 220 | ||
| Pulse (/min) | ≤ 40 | 41–50 | 51–90 | 91–110 | 111–130 | ≥ 131 | |
| Consciousness (ACVPU) | Alert (A) | C / V / P / U | |||||
| Temperature (°C) | ≤ 35.0 | 35.1–36.0 | 36.1–38.0 | 38.1–39.0 | ≥ 39.1 |
* SpO₂ Scale 2 applies only to patients at confirmed risk of hypercapnic respiratory failure (e.g. COPD, neuromuscular disease); target saturation 88–92%. All other patients use Scale 1.
Clinical Risk & Response
| NEWS2 Score | Clinical Risk | Monitoring | Response |
|---|---|---|---|
| 0 | Minimum | 12-hourly | Continue routine assessment |
| 1–4 | Low | 4–6 hourly | Ward nurse informs responsible clinician |
| 3 in any parameter | Medium | Min. 1-hourly | Urgent ward-based response |
| 5–6 | Medium | Min. 1-hourly | Urgent ward-based response |
| ≥ 7 | High | Continuous | Emergency response team |
ACVPU Consciousness Scale
NEWS2 replaced the original AVPU scale with ACVPU, adding "C" for new confusion or delirium as a distinct level between Alert and Voice response:
| Level | Description | Score |
|---|---|---|
| A — Alert | Fully awake and oriented | 0 |
| C — Confusion | New confusion, disorientation, or delirium | 3 |
| V — Voice | Responds to voice but not alert | 3 |
| P — Pain | Responds only to painful stimulus | 3 |
| U — Unresponsive | No response to any stimulus | 3 |
Literature
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. ISBN 978-1-86016-715-2.
Smith GB, Redfern OC, Pimentel MAF, et al. The National Early Warning Score 2 (NEWS2). Clin Med (Lond). 2019;19(3):260–261.
Pimentel MAF, Redfern OC, Gerry S, et al. A comparison of the ability of NEWS and NEWS2 to identify patients at risk of in-hospital mortality. Resuscitation. 2019;134:147–156.
Calculate NEWS2 interactively with automatic SpO₂ scale switching.
Open in Scores2GoFor research and educational purposes only. Not intended for direct clinical decision-making.