The purpose and evolution of Early Warning Scores
Early Warning Scores (EWS) are standardized systems used by healthcare professionals to detect and respond to acute clinical deterioration in adult patients. These scores provide a consistent method for assessing illness severity and triggering an appropriate clinical response. The initial National Early Warning Score (NEWS) was introduced in 2012 by the Royal College of Physicians (RCP) to standardize patient acuity assessment across the NHS.
Based on user feedback and new evidence, NEWS was updated to NEWS2 in December 2017 to enhance patient safety and scoring accuracy. Key changes focused on identifying subtle deterioration signs, like new confusion, and managing oxygen therapy safely in specific patients. NEWS2 is now the mandated standard in the NHS for acute care clinical assessment.
Core physiological parameters in NEWS2
Both NEWS and NEWS2 utilize the same six core physiological parameters, each scored from 0 to 3, which are summed to create a total score. These parameters include:
- Respiratory Rate
- Oxygen Saturation (SpO2)
- Supplemental Oxygen Use
- Systolic Blood Pressure
- Pulse Rate
- Consciousness Level (AVPU scale)
- Temperature
Key differences between NEWS and NEWS2
NEWS2 introduced two main clinical modifications and a design update to improve usability and accuracy, particularly for specific patient groups and deterioration signs.
1. New-onset confusion: A new point was added to the consciousness assessment to specifically identify new confusion, disorientation, or agitation. This change highlights the importance of these signs in signaling acute decline, especially in older patients. The original NEWS might not have captured this nuance as a patient could be 'Alert' despite new confusion.
2. A second oxygen saturation scale (Scale 2): NEWS2 added a dedicated oxygen saturation scale (Scale 2) for patients with, or at risk of, hypercapnic respiratory failure (e.g., COPD). This prevents potentially harmful over-oxygenation in this group. Scale 2 targets a safer range of 88-92%, while Scale 1 for standard patients targets 94-98%.
3. Redesigned chart: The NEWS2 chart was redesigned with an updated color scheme for colorblind users and reordered to align with the ABCDE format for clinical assessment.
Comparison Table: NEWS vs. NEWS2
| Feature | NEWS (2012) | NEWS2 (2017) | Implication of Change |
|---|---|---|---|
| Level of Consciousness | Assessed with AVPU (Alert, Verbal, Pain, Unresponsive). | Assessed with AVPU + New Confusion added as a distinct scoring parameter. | Increased sensitivity for detecting subtle neurological changes, especially in older adults or those with delirium/sepsis. |
| Oxygen Saturation | Single scale for all patients (target 94–98%), potentially leading to over-oxygenation in specific patients. | Two scales: Scale 1 (target 94–98%) for most patients; Scale 2 (target 88–92%) for patients with confirmed hypercapnic respiratory failure. | Acknowledges that appropriate oxygen levels differ for some patients, preventing potentially harmful oxygen overuse. |
| Chart Design | Red/Amber/Green color scheme, which posed problems for color-blind staff. | Updated color scheme to accommodate color-blindness and reordered to follow the ABCDE assessment format. | Improved accessibility and alignment with standard clinical assessment practice. |
| Sepsis Recognition | Score of ≥5 indicates a higher risk of adverse outcomes. | Confirmed use of a score of ≥5 as a trigger for considering sepsis, reinforcing national guidance. | Formalized the use of the score in sepsis management pathways to prompt earlier intervention. |
What the NEWS2 update means for patient care
NEWS2 significantly improved patient care and safety by making the Early Warning Score system more robust and accurate, particularly in complex cases.
- Improved Sepsis Detection: The addition of 'new confusion' and the validated use of a score of 5 or more to 'think sepsis' has standardized and sped up the recognition and treatment of sepsis.
- Enhanced Safety in Respiratory Care: Scale 2 is a crucial safety feature, ensuring patients at risk of hypercapnic respiratory failure receive appropriate oxygen therapy.
- Better Communication: NEWS2 acts as a 'common language' for acuity, improving communication between healthcare providers, such as ambulance and hospital staff.
- Adjunct to Clinical Judgment: NEWS2 supports clinical judgment but does not replace it. Professionals use the score with other assessments and patient concerns for a holistic view.
Conclusion: Standardizing care with NEWS2
The transition from NEWS to NEWS2 reflects ongoing efforts to improve clinical tools based on experience and evidence. The changes, including the 'new confusion' parameter and the second oxygen saturation scale, provide a more sensitive and safer way to assess acutely unwell adults. While both systems aim to standardize care, NEWS2 offers greater nuance and accuracy, leading to better identification of at-risk patients and more timely interventions. For detailed information, consult the Royal College of Physicians website.
Note: This article is for general information only and is not a substitute for professional medical advice or official clinical guidance. Always consult a healthcare provider for medical concerns.
Reference: Royal College of Physicians. (2017). National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. {Link: RCP website https://www.rcp.ac.uk/improving-care/resources/national-early-warning-score-news-2/}
