What is NEWS2 (National Early Warning Score 2)?
NEWS2 is the standardized system, developed by the Royal College of Physicians, for the early recognition of clinical deterioration in the adult patient. It scores six vital signs and any supplemental oxygen therapy: the sum (0 to 20) stratifies risk and indicates monitoring frequency and any care escalation.
NEWS2 scoring table
Each parameter contributes a score from 0 to 3 based on its value:
| Parameter | 3 | 2 | 1 | 0 | 1 | 2 | 3 |
|---|---|---|---|---|---|---|---|
| Respiratory rate (breaths/min) | ≤8 | · | 9–11 | 12–20 | · | 21–24 | ≥25 |
| SpO₂ — Scale 1 (%) | ≤91 | 92–93 | 94–95 | ≥96 | · | · | · |
| Air or oxygen | · | O₂ | · | Air | · | · | · |
| Systolic BP (mmHg) | ≤90 | 91–100 | 101–110 | 111–219 | · | · | ≥220 |
| Heart rate (bpm) | ≤40 | · | 41–50 | 51–90 | 91–110 | 111–130 | ≥131 |
| Temperature (°C) | ≤35.0 | · | 35.1–36.0 | 36.1–38.0 | 38.1–39.0 | ≥39.1 | · |
| Consciousness (ACVPU) | · | · | · | A | · | · | C·V·P·U |
The numbers in the header are the points assigned. In patients at risk of hypercapnic respiratory failure (e.g. COPD), SpO₂ Scale 2 is used, targeting 88–92%.
Thresholds and clinical response
- NEWS2 0 — Low — routine. Monitor at least every 12 hours
- NEWS2 1–4 — Low. Nursing reassessment, monitor every 4–6 hours
- NEWS2 3 on a single parameter — Low-medium. Urgent review, monitor at least hourly
- NEWS2 5–6 — Medium. Urgent physician review, hourly monitoring, consider critical care area
- NEWS2 ≥7 — High. Activate emergency team, continuous monitoring, critical care area
Difference between NEWS and NEWS2
NEWS2 (2017) updates the original NEWS by introducing a second saturation scale for patients with hypercapnic respiratory failure, adding oxygen therapy as a variable, and adopting the ACVPU scale (Alert, Confusion, Voice, Pain, Unresponsive), which also accounts for new-onset confusion.
What is MEWS (Modified Early Warning Score)?
MEWS (Modified Early Warning Score) is the early warning system that preceded NEWS2, still in use in various local protocols. It evaluates five vital signs — systolic blood pressure, heart rate, respiratory rate, temperature, and level of consciousness per the AVPU scale — with a score that stratifies risk and guides monitoring frequency and any medical alert.
MEWS scoring table
Each parameter contributes a score based on its value:
| Parameter | 3 | 2 | 1 | 0 | 1 | 2 | 3 |
|---|---|---|---|---|---|---|---|
| Systolic BP (mmHg) | ≤70 | 71–80 | 81–100 | 101–199 | · | ≥200 | · |
| Heart rate (bpm) | · | ≤40 | 41–50 | 51–100 | 101–110 | 111–129 | ≥130 |
| Respiratory rate (breaths/min) | · | <9 | · | 9–14 | 15–20 | 21–29 | ≥30 |
| Temperature (°C) | · | <35.0 | · | 35.0–38.4 | · | >38.4 | · |
| Consciousness (AVPU) | · | · | · | A | V | P | U |
MEWS thresholds and clinical response
- MEWS 0–2 — Stable. Routine monitoring
- MEWS 3–4 — Attention. Increase monitoring frequency, alert the physician
- MEWS ≥5 — Urgent. Immediate urgent medical review
NEWS2 or MEWS: which to use?
NEWS2 has replaced MEWS as the recommended standard in the UK and in more recent literature, thanks to broader validation and the inclusion of oxygen therapy and the ACVPU scale. MEWS is still common in local protocols that have not yet adopted NEWS2: use the calculator mode that matches the protocol used in your unit.
Sources: Royal College of Physicians. National Early Warning Score (NEWS) 2. London: RCP, 2017. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94(10):521-526. This tool is for educational and support purposes: it does not replace clinical judgment or local protocols.