NEWS2 calculator
Seven bedside observations give the National Early Warning Score 2.
Educational tool, not medical advice. Do not use this page to monitor or triage a patient. Hospitals use the official NEWS2 chart or their electronic record, with local escalation policies. If someone is very short of breath, confused or collapsing, call emergency services (911 in the US). Scoring system © Royal College of Physicians 2017. How we check our calculators.
Why hospitals use an early warning score
A patient who is about to deteriorate usually shows it in the vital signs hours before a crisis. The difficulty is that each abnormal reading looks modest by itself and different staff react differently. NEWS2 gives every ward the same arithmetic: points for each observation according to how far it is from normal, a total, and thresholds that match a standard level of response. This page is a learning aid for nurses and students who want to practise the scoring or check their understanding. It is not a clinical record and not the official chart.
What is NEWS2?
NEWS2 is the National Early Warning Score 2, published by the Royal College of Physicians (RCP) in London in December 2017. It adds points for seven routine observations so that staff can spot a patient who is getting worse and call for help in a standard way. It updated the first NEWS of 2012 and has been endorsed by NHS England for adult patients in hospital. It is not intended for children or for pregnant women, who have their own scores.
Which seven observations are scored?
Respiration rate, oxygen saturation (SpO2), whether the patient is breathing air or supplemental oxygen, systolic blood pressure, pulse rate, level of consciousness or new confusion, and temperature. Each is scored from 0 to 3, except that needing oxygen adds 2, so the aggregate runs from 0 to 20. Consciousness is read on the ACVPU scale (Alert, new Confusion, Voice, Pain, Unresponsive); anything other than alert scores 3.
How is each observation scored?
Respiration rate: 12 to 20 per minute scores 0; 9 to 11 scores 1; 21 to 24 scores 2; 8 or fewer, or 25 or more, scores 3. SpO2 on scale 1: 96 percent or more scores 0; 94 to 95 scores 1; 92 to 93 scores 2; 91 or less scores 3. Systolic pressure: 111 to 219 mm Hg scores 0; 101 to 110 scores 1; 91 to 100 scores 2; 90 or less, or 220 or more, scores 3. Pulse: 51 to 90 scores 0; 41 to 50 or 91 to 110 scores 1; 111 to 130 scores 2; 40 or less, or 131 or more, scores 3. Temperature: 36.1 to 38.0 °C scores 0; 35.1 to 36.0 or 38.1 to 39.0 scores 1; 39.1 or more scores 2; 35.0 or less scores 3. These are the figures on the RCP chart.
What are the risk bands?
The RCP chart sorts the result into clinical risk. An aggregate score of 0 to 4 is low. A score of 3 in any single parameter is called low-medium and, according to the report, should prompt an urgent review by a clinician to find the cause. An aggregate of 5 or 6 is medium, the key threshold for an urgent response. An aggregate of 7 or more is high, and the report links it to an emergency response by a team with critical care skills. What actually happens is decided by local hospital policy.
What is SpO2 scale 2?
The RCP added a second oxygen saturation scale for patients with hypercapnic (type 2) respiratory failure, who are given a target of 88 to 92 percent so that too much oxygen does not worsen carbon dioxide retention. The report recommends that scale 2 is used only for patients confirmed to have hypercapnic respiratory failure on blood gas analysis, that the decision is made by a competent clinical decision maker and recorded in the notes, and that scale 1 is used in all other cases. The choice matters: with a saturation of 90 percent on oxygen, scale 1 scores 3 while scale 2 scores 0.
May this calculator be used? What is the licence?
The RCP report says there is no copyright restriction on the material, to encourage as many people as possible to use it, but that the RCP as copyright holder must be acknowledged on material reproduced from it. Its frequently asked questions say the same applies when the score is built into an electronic system. The charts themselves must be reproduced in colour and not modified. This page therefore calculates the score from the published values and acknowledges the RCP (© Royal College of Physicians 2017). It is not the official chart. Staff should use their hospital’s approved NEWS2 chart or electronic record.
Does a low score mean a patient is safe?
No. The report itself says NEWS2 should supplement clinical judgment, not replace it, and its COVID-19 guidance notes that any increase in oxygen requirement should trigger an escalation call even if the oxygen item (yes or no) does not change the score. The RCP calls the score a standardized way to assess acute illness severity and to prompt a response.
Worked examples
A resting adult with a respiration rate of 16, SpO2 of 97 percent on air, systolic pressure of 120, pulse of 72, alert and a temperature of 98.6 °F (37.0 °C) scores 0. A second patient has a respiration rate of 24, SpO2 of 93 percent on oxygen, a pressure of 105, a pulse of 112 and a temperature of 101.5 °F (38.6 °C): that adds 2 + 2 + 2 + 1 + 2 + 0 + 1 = 10, which falls in the high risk band. Someone whose only abnormal finding is a pulse of 38 scores 3, which the chart calls low-medium because of the single parameter at 3.
Limits of this method
The score uses single observations and so is only as good as the observations: an inaccurate reading changes the points as surely as a real change in the patient does. The RCP report states that the score for oxygen is binary, and says nothing about how much oxygen is being given. NEWS2 is for adults only; the report describes its use in hospitals and in prehospital care such as ambulances. The report also describes the “new confusion” item as subtle: a patient may answer questions coherently and still be confused.
Common mistakes
A common slip is leaving an observation out, which some tools silently count as zero; this page asks for all seven. The RCP publishes separate guidance on what to do when a NEWS2 score is incomplete. Entering a temperature in the wrong unit is another: the chart is in °C, and this page converts °F to the nearest tenth of a degree Celsius. Using SpO2 scale 2 for a patient who has not been confirmed to have hypercapnic respiratory failure will lower the score and may hide a deteriorating patient, which is why the report assigns that decision to a competent clinician.
Sources: Royal College of Physicians, National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party, London: RCP, 2017 (charts 1, 2 and 4; recommendations on SpO2 scale 2; the “Copyright” page and questions 18, 20 and 25 of the appendix), available from rcp.ac.uk/resources/national-early-warning-score-news-2. © Royal College of Physicians 2017; acknowledged as the report requests. Related: Glasgow Coma Scale, mean arterial pressure, CURB-65.
For general information only — not medical advice, and not a tool for patient care decisions. Talk with a doctor or call emergency services about anyone you are worried about. How we check our calculators.