The NEWS score was originally developed as a way to standardize patient assessment, especially for acute illnesses where time is paramount, and a common communication paradigm between caregivers could potentially save lives. Since its introduction in 2012, the score has gained worldwide popularity and has proven useful in hospitals and other care settings in Europe, the USA (including the US Naval and Air Forces) and India. This popularity can be attributed to the score's high accuracy in predicting mortality. [7] It takes into account both extremes of the parameters it measures; for example, high as well as low blood pressure, can raise the score depending on the values.
The predictive power of the NEWS & NEWS 2 Scores is practically indistinguishable between the two. In some studies, the original is slightly better at predicting IHCA events or need for ICU care, the difference is statistically insignificant. However, for both parameters, overall results are still poor, and the use of more specialized scores is advised. The small differences between the scores are probably due to the fact that HRCF (Hypercapnic Respiratory Failure) is sometimes not confirmed before utilizing the second O2 table provided in the new score, an error that would result in lower scores for some more severe patients [2], [3].
In recent years, numerous studies have been conducted to validate the predictive power of the new score and its use in the emergency department. For example, a study released in 2021, involving 3986 patients, successfully confirmed the score's accuracy in predicting mortality rates and challenged other studies' results. It showed that the score was even successful at predicting the need for ICU (Intensive Care Unit) management, which was correlated with mortality (AUC of 0.97-0.92) [4]. The mean NEWS-2 Score for patients who were eventually transferred to the ICU was 7. Only 2% of all patients required ICU care, but 41% of those who died. [4] Among patients with a NEWS-2 score higher than 10, 38.6% died, suggesting a high correlation [4]
Another study on 39,470 admissions (of which 2,361 had AECOPD - acute exacerbation of chronic obstructive pulmonary disease - with a median age of 74 years) found that the sensitivity of the NEWS-2 Score was merely 28%, compared to the original score's 50%. However, specificity was higher at 93% (vs. 80%). [5]
While results have been mixed, as with any score, the NEWS & NEWS 2 scores should offer reasonably good mortality prediction values and be a reasonable pillar in the management of acutely ill patients.
The main updates that were made to the NEWS score were an improvement of the chart used to record patient data over time. The change was made to conform to the ABCDE approach that is recommended by the UK Resuscitation Council. In the new score, the temperature stands for Exposure [2].
A new addition to the NEWS 2 Score was a secondary chart/scale for recording the evolution of the respiratory system in patients with hypercapnic respiratory failure, who usually have lower O2 Saturation recommendations of 88-92% (which have been shown to lower mortality rates in COPD patients). [1][2], [6]
While there weren't any major changes made between the scores, it is important to keep in mind that these scores were specifically designed by the Royal College of Physicians (RCP) as a way to standardize the assessment and management of patients across all the UK's Acute Care Facilities. With the introduction of the new score and chart, the RCP recommends switching over to the new chart when recording vital sign or other observation charts [2].
A download of the RCP publication about the NEWS 2 Score, including the chart (at page 58/77), can be downloaded here.
Several other tools similar to the NEWS score are used for patient assessment and prediction of clinical outcomes. Some notable ones include:
These tools, including the NEWS score, serve as valuable aids in the assessment and management of patients, allowing healthcare providers to identify those at higher risk of clinical deterioration and make timely interventions.
The National Early Warning Score (NEWS) is a standardized scoring system used by healthcare professionals to quickly assess the severity of a patient's illness and determine the appropriate level of clinical response. It was developed by the Royal College of Physicians (RCP) in the United Kingdom and is now widely used in many countries.
The primary purpose of the NEWS is to identify patients who are at risk of deteriorating or experiencing a life-threatening event, such as sepsis, cardiac arrest, or respiratory failure. By using a simple and consistent scoring method, healthcare professionals can monitor patients' vital signs and identify those who need urgent attention or intervention.
Each parameter is assigned a score (from 0 to 3) based on the measurement value and its deviation from the normal range. The scores for each parameter are then added up to produce a total NEWS score, which can range from 0 to 20. A higher score indicates a greater risk of deterioration or a life-threatening event.
The primary purpose of the NEWS score is to provide a standardized and objective method for healthcare professionals to assess a patient's clinical status and identify those who may be at risk of deterioration. It helps to ensure a consistent approach to monitoring and escalation of care.
The use of the NEWS system has several benefits, including:
The NEWS score can also be used to determine the frequency of vital sign monitoring and the need for additional interventions or consultations with specialized healthcare teams. It has also developed into a vital communication tool among healthcare providers to facilitate effective and timely decision-making regarding patient care.
In summary, the National Early Warning Score is a valuable tool that helps healthcare professionals quickly assess the severity of a patient's illness, identify those at risk of deterioration or life-threatening events, and guide the appropriate clinical response. By promoting clear communication and timely intervention, the NEWS system can contribute to improved patient outcomes and more efficient use of healthcare resources.
Calculator, National Early Warning Score (NEWS), Scoring system, Severity assessment, Clinical response, Healthcare professionals, Patient deterioration, Life-threatening events, Vital signs, Physiological parameters, Respiratory rate, Oxygen saturation, Systolic blood pressure, Pulse rate, Temperature, Level of consciousness, AVPU scale, Risk assessment, Communication, Intervention, Resource allocation, Benchmarking, Quality improvement, Vital sign monitoring, Decision-making, Patient care.Understanding and Using the National Early Warning Score (NEWS/NEWS 2)The NEWS/2 Score0000