National Early Warning Score (NEWS) Calculator

The National Early Warning Score evaluates the degree of illness in patients who are likely to suffer from decline of status and be admitted in intensive care (ICU).

NEWS is based on 5 physiological parameters, the level of consciousness status (AVPU) and presence or absence of supplemental oxygen.

Each of the items in the score is weighted differently, depending on its predictive value. The final score varies from 0 to 20.

Patients who score closer to 0 are less likely to require advanced clinical care whilst patients who score 5 or 6 points may end up being referred to ICU and require specialist attention.

Patients who score 7 or more are likely in need of urgent critical care and need to be transferred to the appropriate specialized department.

NEWS explained

The National Early Warning Score (NEWS) determines how severe the general status of the patient is and the likelihood of decline which in turn requires admission to intensive care unit for more specialized care.

NEWS is based on the Modified Early Warning Score (MEWS) and is based solely on physiological bedside parameters and AVPU evaluation.

The items accounted for in the score are described in the table below:

NEWS	Description
Respiratory rate	Assesses the level of distress caused by illness to the pulmonary system and to the central nervous system areas that regulate breathing. It is counted in breaths per minute and ranges between under 8 to over 25.
Oxygen saturation	Levels of oxygen saturation below 91 and those above 96 become increasingly problematic and trigger need for more specialized care.
Oxygen supplementation
Body temperature	To provide patient baseline and signal infection.
Systolic blood pressure	Offer information on the work of the heart and on blood circulation throughout the arteries and veins.
Heart rate
AVPU	The level of consciousness assessment (Alert, react to Verbal, reacts to Pain, Unresponsive).

This model standardizes the clinical assessment of ill patients that might require critical care intervention. The weights awarded to each item are presented below:

National Early Warning Score (NEWS)
Physiological parameters	3	2	1	0	1	2	3
Respiration Rate	≤8	N/A	9 - 11	12 - 20	N/A	21 - 24	≥25
Oxygen Saturation	≤91	92 - 93	94 - 95	≥96	N/A
Supplemental Oxygen	N/A	Yes	N/A	No	N/A
Temperature	≤35	N/A	35.1 - 36	36.1 - 38	38.1 - 39	≥39.1	N/A
Systolic Blood Pressure	≤90	91 - 100	101 - 110	111 - 219	N/A		≥220
Heart Rate	≤40	N/A	41 - 50	51 - 90	91 - 110	111 - 130	≥131
AVPU score	N/A			A	N/A		V, P or U

Should also be noted that if an item scores 3 points and the final score is of 3 or 4, despite the fact that the final score indicates low chance of ICU, the patient should still be monitored, especially on the component where they scored 3 points.

Scores such as NEWS or MEWS are not addressed to admission only, like the Injury severity score or the Glasgow Coma Scale are, but they should be assessed regularly during hospital admission of patients with significant illness.

There is also a version of the score for use in pediatric patients, the PEWS, where the risk of status deterioration is assessed based on behaviour, cardiovascular and respiratory signs and urinary output.

Interpretation

The scoring system involves addition of points that are awarded to the items, depending on their predictive value (the patient needing intensive care unit supervision) and the severity of the condition.

In the following table, there is a summary of the association between the NEWS results, likelihood of ICU admission and further recommendations:

NEWS	Likelihood of ICU	Recommendation
0 - 4	Very low	Clinical monitoring should be continued and the medical professional, usually a registered nurse will decide further if clinical care needs to be updated.
5, 6	Moderate	The patient should be reviewed by a medical specialist with competencies in acute illness, evaluation that may result in the referral to ICU.
≥7	High	Urgent critical care is need and the patient should be transferred to the appropriate specialized department for further care.