Expansion
Six physiological parameters plus supplemental oxygen
Expansion
Parameters
- Respiratory rate
- Oxygen saturation (with a separate scale 2 for those with hypercapnic respiratory failure, targeting 88 to 92 per cent)
- Supplemental oxygen: any oxygen scores 2
- Systolic blood pressure
- Pulse
- Level of consciousness (ACVPU, where new confusion scores 3)
- Temperature
Thresholds
- Total 5 or more, or any single parameter scoring 3: urgent clinical review
- Total 7 or more: emergency response, critical care involvement
Why it works: deterioration is preceded by hours of abnormal physiology, and the score captures it before the diagnosis is apparent.
Respiratory rate deserves particular emphasis. It is the earliest parameter to change, it is the strongest single predictor, and it is the one most often estimated rather than counted. Counting it for a full minute is a genuinely high-value act.
Limitations: NEWS2 is less reliable in pregnancy, children (where PEWS is used), and in chronic physiological abnormality. It supports rather than replaces clinical judgement, and a patient who looks unwell with a low score still needs review.