Critical Care Scores

National Early Warning Score 2 (NEWS2) Calculator

Scores six vital signs plus oxygen use to spot deterioration in adults and set the urgency of review.

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Turn on JavaScript to use this calculator, or open it in the web app.

Formula

Respiratory rate: 8 or less +3, 9–11 +1, 12–20 0, 21–24 +2, 25 or more +3
SpO₂ Scale 1: 91 or less +3, 92–93 +2, 94–95 +1, 96 or more 0
SpO₂ Scale 2: 83 or less +3, 84–85 +2, 86–87 +1, 88–92 or 93 or more on air 0; on oxygen 93–94 +1, 95–96 +2, 97 or more +3
Air 0, supplemental oxygen +2
Systolic BP: 90 or less +3, 91–100 +2, 101–110 +1, 111–219 0, 220 or more +3
Pulse: 40 or less +3, 41–50 +1, 51–90 0, 91–110 +1, 111–130 +2, 131 or more +3
Consciousness: alert 0; new confusion, voice, pain or unresponsive (CVPU) +3
Temperature (°C): 35.0 or less +3, 35.1–36.0 +1, 36.1–38.0 0, 38.1–39.0 +1, 39.1 or more +2
Total 0–4 low, a 3 in any one parameter low–medium, 5–6 medium, 7 or more high

How it is used

• Response by score: 0, observations at least every 12 h; 1–4, the registered nurse assesses and decides on frequency (at least every 4–6 h); a 3 in one parameter, inform the medical team and observe at least hourly; 5 or more, urgent assessment by a clinician competent in acute illness and at least hourly observations; 7 or more, emergency assessment by a team with critical care and airway skills, continuous monitoring and consideration of HDU or ICU (RCP 2017).
• Use SpO₂ Scale 2 only for hypercapnic respiratory failure confirmed on a blood gas with a prescribed 88–92% target, chosen by a competent clinical decision maker and recorded in the notes; everyone else uses Scale 1 (RCP 2017).
• New confusion, disorientation, delirium or any acute fall in GCS scores 3; if it is unclear whether confusion is new, treat it as new until confirmed otherwise (RCP 2017).
• Not for children under 16 or pregnant women; may be unreliable in spinal cord injury, especially tetraplegia or high paraplegia (RCP 2017).

Key points

• A score of 5 or more is the key trigger for urgent clinical review; in known or suspected infection, think of sepsis (RCP 2017).

Same formula as the app. Open it in the web app.

Related one-pagers

• Sepsis and Septic Shock BundleNEWS2 of 5 or more, or 3 in one parameter, prompts urgent review, and 7 or more an emergency response (RCP 2017). The Epic model alerted on 18% of all inpatients yet missed two thirds of sepsis (Wong 2021).

Related calculators

• Pneumonia Severity Score (CURB-65)
• Sequential Organ Failure Assessment (SOFA)

For education and exam preparation only. Follow your institution’s protocols. For education and exam preparation only. Verify results independently and follow your institution’s protocols. Not a substitute for clinical judgment.