Scoring (RCP NEWS2, 2017, reproduced exactly).

• Respiration rate ≤8 → 3 · 9–11 → 1 · 12–20 → 0 · 21–24 → 2 · ≥25 → 3
• SpO₂ Scale 1 (target 94–98 %) ≤91 → 3 · 92–93 → 2 · 94–95 → 1 · ≥96 → 0
• SpO₂ Scale 2 (target 88–92 %) ≤83 → 3 · 84–85 → 2 · 86–87 → 1 · 88–92 → 0 · ≥93 on air → 0 · 93–94 on oxygen → 1 · 95–96 on oxygen → 2 · ≥97 on oxygen → 3
• Supplemental oxygen yes → 2 · no → 0 (added on either scale)
• Systolic blood pressure ≤90 → 3 · 91–100 → 2 · 101–110 → 1 · 111–219 → 0 · ≥220 → 3
• Pulse ≤40 → 3 · 41–50 → 1 · 51–90 → 0 · 91–110 → 1 · 111–130 → 2 · ≥131 → 3
• Temperature ≤35.0 → 3 · 35.1–36.0 → 1 · 36.1–38.0 → 0 · 38.1–39.0 → 1 · ≥39.1 → 2
• ACVPU Alert → 0 · new Confusion, Voice, Pain or Unresponsive → 3

Total range 0–20. Scale 2 is only used for patients with a confirmed target saturation of 88–92 %, almost always hypercapnic respiratory failure, and only on a clinician's instruction — on Scale 2 a saturation of 93 % or more on oxygen scores points, because over-oxygenation in a CO₂ retainer is itself the danger.

Escalation (RCP clinical response). 0 — very low risk: minimum 12-hourly observations. 1–4 with no parameter at 3 — low risk: ward-based care, registered nurse to review, minimum 4–6 hourly. Any single parameter scoring 3 — low-medium risk: ward-based but urgent same-day review by a clinician competent in assessing acute illness, at least 4-hourly monitoring. This overrides a low total: a respiratory rate of 8 scores 3 and triggers this response even if the NEWS2 total is 3. 5–6 — medium risk: emergency response, urgent medical review, ward with monitoring facilities, at least hourly. ≥7 — high risk: emergency clinical review, critical care outreach, continuous monitoring.

Sepsis. A NEWS2 of 5 or more with suspected infection is the usual trigger in UK practice for a sepsis screening pathway and the Sepsis Six bundle within the hour. New confusion scoring 3 is often the only sign in an older patient.

Worked example. Respiratory rate 22 (2), SpO₂ 92 % on Scale 1 (2), on oxygen (2), systolic 98 (2), pulse 115 (2), alert (0), temperature 38.4 °C (1) = 11, high risk, emergency response. Now change the SpO₂ to 97 % on oxygen: Scale 1 gives 0 for the saturation, the total drops to 9, still high risk — but on Scale 2 that same 97 % on oxygen would score 3, and the total would be 12. The scale choice is a clinical decision with a two-point consequence, which is why it is an explicit control here rather than a default.

What NEWS2 cannot tell you. It is a deterioration trigger, not a diagnosis, and a low score does not make a patient safe — young, fit and beta-blocked patients compensate for a long time and then collapse, and the score is blind to pain, bleeding volume, urine output, capillary refill, lactate and the clinical impression that usually arrives before any number does. It is validated in adults (16 and over) and is not a paediatric score. It assumes accurate observations: a rate counted over 15 seconds and multiplied by four, a saturation reading on a cold peripherally vasoconstricted hand, or a blood pressure taken on the wrong cuff size all move the score without moving the patient. A single score is far less useful than the trend, and a rising score matters more than any absolute value.

Disclaimer. A scoring aid for qualified clinicians — not medical advice, and never a reason to delay escalation you think is needed. Escalate on clinical concern regardless of the number. Source: Royal College of Physicians, National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS, 2017. Last reviewed: 2026-09-21.