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NEWS2 (National Early Warning Score 2)

A Royal College of Physicians early warning score combining six physiological parameters and supplemental oxygen use to support assessment of clinical deterioration in adults.

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Method · Limits of application

NEWS 2/Royal College of Physicians December 2017: 6 parameters, 2 SpO₂ scales, +2 oxygen; not NEWS 2012

NEWS2 is intended for assessing people aged 16 years or older; it must not be used as a validated score in children under 16 or pregnant women. Use SpO₂ Scale 2 only for hypercapnic respiratory failure confirmed by blood gas analysis during the current or a previous admission, with a prescribed saturation target of 88–92% and a documented decision by a competent clinical professional. In other situations, use Scale 1. The total supports assessment of deterioration and does not generate an automatic care order.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Respiratory rate · breaths/min
SpO₂ · %
SpO₂ scale
Receiving oxygen?
Systolic blood pressure · mmHg
Heart rate · bpm
Level of consciousness
Temperature · °C

6/6 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Respiratory rate: ≤ 8 = 3; 9–11 = 1; 12–20 = 0; 21–24 = 2; ≥ 25 = 3.
SpO₂ scale 1: ≤ 91 = 3; 92–93 = 2; 94–95 = 1; ≥ 96 = 0.
SpO₂ scale 2: ≤ 83 = 3; 84–85 = 2; 86–87 = 1; 88–92 (or ≥ 93 on room air) = 0; 93–94 with O₂ = 1; 95–96 with O₂ = 2; ≥ 97 with O₂ = 3.
Supplemental oxygen: 2.
Systolic blood pressure: ≤ 90 = 3; 91–100 = 2; 101–110 = 1; 111–219 = 0; ≥ 220 = 3.
Heart rate: ≤ 40 = 3; 41–50 = 1; 51–90 = 0; 91–110 = 1; 111–130 = 2; ≥ 131 = 3.
Consciousness: alert = 0; new confusion, voice, pain or unresponsive = 3.
Temperature: ≤ 35.0 = 3; 35.1–36.0 = 1; 36.1–38.0 = 0; 38.1–39.0 = 1; ≥ 39.1 = 2.

References

Identifier: news2

Original clinical content: Brazilian Portuguese.

Method version

NEWS 2/Royal College of Physicians December 2017: 6 parameters, 2 SpO₂ scales, +2 oxygen; not NEWS 2012

news2@native-2026-10-05+9ec0a49cc8e3

Royal College of Physicians. National Early Warning Score (NEWS) 2: standardising the assessment of acute-illness severity in the NHS. Londres, 2017.

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (6)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Respiratory rate: 16 breaths/min
SpO₂: 97 %
SpO₂ scale: Scale 1 (standard)
Receiving oxygen?: Room air
Systolic blood pressure: 125 mmHg
Heart rate: 75 bpm
Level of consciousness: Alert
Temperature: 36.8 °C

{
  "fr": 16,
  "spo2": 97,
  "escala": "1",
  "o2": "0",
  "pas": 125,
  "fc": 75,
  "consc": "a",
  "temp": 36.8
}

Expected result

{
  "score": 0,
  "level": "low"
}

Actual result

{
  "score": 0,
  "red": 0,
  "sat": 0
}

Case 2

reference-002

Inputs

Respiratory rate: 16 breaths/min
SpO₂: 97 %
SpO₂ scale: Scale 1 (standard)
Receiving oxygen?: Room air
Systolic blood pressure: 125 mmHg
Heart rate: 75 bpm
Level of consciousness: New confusion, responds to voice, responds to pain or unresponsive
Temperature: 36.8 °C

{
  "fr": 16,
  "spo2": 97,
  "escala": "1",
  "o2": "0",
  "pas": 125,
  "fc": 75,
  "consc": "cvpu",
  "temp": 36.8
}

Expected result

{
  "red": 1
}

Actual result

{
  "score": 3,
  "red": 1,
  "sat": 0
}

Case 3

reference-003

Inputs

Respiratory rate: 22 breaths/min
SpO₂: 95 %
SpO₂ scale: Scale 1 (standard)
Receiving oxygen?: Room air
Systolic blood pressure: 105 mmHg
Heart rate: 95 bpm
Level of consciousness: Alert
Temperature: 38.3 °C

{
  "fr": 22,
  "spo2": 95,
  "escala": "1",
  "o2": "0",
  "pas": 105,
  "fc": 95,
  "consc": "a",
  "temp": 38.3
}

Expected result

{
  "score": 6,
  "level": "mid",
  "verdict": "médio"
}

Actual result

{
  "score": 6,
  "red": 0,
  "sat": 1
}

Case 4

reference-004

Inputs

Respiratory rate: 26 breaths/min
SpO₂: 91 %
SpO₂ scale: Scale 1 (standard)
Receiving oxygen?: Supplemental oxygen
Systolic blood pressure: 88 mmHg
Heart rate: 120 bpm
Level of consciousness: New confusion, responds to voice, responds to pain or unresponsive
Temperature: 39.5 °C

{
  "fr": 26,
  "spo2": 91,
  "escala": "1",
  "o2": "1",
  "pas": 88,
  "fc": 120,
  "consc": "cvpu",
  "temp": 39.5
}

Expected result

{
  "score": 18,
  "level": "high"
}

Actual result

{
  "score": 18,
  "red": 1,
  "sat": 3
}

Case 5

reference-005

Inputs

Respiratory rate: 18 breaths/min
SpO₂: 90 %
SpO₂ scale: Scale 2 (confirmed hypercapnic respiratory failure; prescribed target 88–92%)
Receiving oxygen?: Supplemental oxygen
Systolic blood pressure: 130 mmHg
Heart rate: 80 bpm
Level of consciousness: Alert
Temperature: 37 °C

{
  "fr": 18,
  "spo2": 90,
  "escala": "2",
  "o2": "1",
  "pas": 130,
  "fc": 80,
  "consc": "a",
  "temp": 37
}

Expected result

{
  "sat": 0
}

Actual result

{
  "score": 2,
  "red": 0,
  "sat": 0
}

Case 6

reference-006

Inputs

Respiratory rate: 18 breaths/min
SpO₂: 97 %
SpO₂ scale: Scale 2 (confirmed hypercapnic respiratory failure; prescribed target 88–92%)
Receiving oxygen?: Supplemental oxygen
Systolic blood pressure: 130 mmHg
Heart rate: 80 bpm
Level of consciousness: Alert
Temperature: 37 °C

{
  "fr": 18,
  "spo2": 97,
  "escala": "2",
  "o2": "1",
  "pas": 130,
  "fc": 80,
  "consc": "a",
  "temp": 37
}

Expected result

{
  "sat": 3
}

Actual result

{
  "score": 5,
  "red": 1,
  "sat": 3
}

This translation has not been specifically approved by the Royal College of Physicians (RCP). Refer to the original English version before any clinical use.

Royal College of Physicians. National Early Warning Score (NEWS) 2. London: RCP, 2017.

Code and reproducibility

This tool’s code on GitHub

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Sources, version and reproduction instructions

README

Local installation

Code license: Apache-2.0

Guidelines and conditions

This repository’s license applies to the code. Third-party instruments, questionnaires, data and models remain subject to their owners’ conditions.

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.