Modifications to the national early warning score 2: a scoping review
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
The National Early Warning Score 2 (NEWS2) has been adopted as the standard approach for early detection of deterioration in clinical settings in the UK, and is also used in many non-UK settings. Limitations have been identified, including a reliance on ‘normal’ physiological parameters without accounting for individual variation.
Objective
This review aimed to map how the NEWS2 has been modified to improve its predictive accuracy while placing minimal additional burden on clinical teams.
Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) and the Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks were followed to structure the review. Six databases (CINAHL, PubMed, Embase, ScienceDirect, Cochrane Library and Web of Science) were searched for studies which reported the predictive accuracy of a modified version of NEWS2. The references were screened based on keywords using EndNote 21. Title, abstract and full-text screening were performed by 2 reviewers independently in Rayyan. Data was extracted into a pre-established form and synthesised in a descriptive analysis.
Results
Twelve studies were included from 12,867 references. In 11 cases, modified versions of NEWS2 demonstrated higher predictive accuracy for at least one outcome. Modifications that incorporated demographic variables, trend data and adjustments to the weighting of the score’s components were found to be particularly conducive to enhancing the predictive accuracy of NEWS2.
Conclusions
Three key modifications to NEWS2—incorporating age, nuanced treatment of FiO2 data and trend analysis—have the potential to improve predictive accuracy without adding to clinician burden. Future research should validate these modifications and explore their composite impact to enable substantial improvements to the performance of NEWS2.
The National Early Warning Score 2 (NEWS2) has been adopted as the standard approach for early detection of deterioration in clinical settings in the UK, and is also used in many non-UK settings. Limitations have been identified, including a reliance on ‘normal’ physiological parameters without accounting for individual variation.
Objective
This review aimed to map how the NEWS2 has been modified to improve its predictive accuracy while placing minimal additional burden on clinical teams.
Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) and the Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks were followed to structure the review. Six databases (CINAHL, PubMed, Embase, ScienceDirect, Cochrane Library and Web of Science) were searched for studies which reported the predictive accuracy of a modified version of NEWS2. The references were screened based on keywords using EndNote 21. Title, abstract and full-text screening were performed by 2 reviewers independently in Rayyan. Data was extracted into a pre-established form and synthesised in a descriptive analysis.
Results
Twelve studies were included from 12,867 references. In 11 cases, modified versions of NEWS2 demonstrated higher predictive accuracy for at least one outcome. Modifications that incorporated demographic variables, trend data and adjustments to the weighting of the score’s components were found to be particularly conducive to enhancing the predictive accuracy of NEWS2.
Conclusions
Three key modifications to NEWS2—incorporating age, nuanced treatment of FiO2 data and trend analysis—have the potential to improve predictive accuracy without adding to clinician burden. Future research should validate these modifications and explore their composite impact to enable substantial improvements to the performance of NEWS2.
Date Issued
2025-03-11
Date Acceptance
2025-02-11
Citation
BMC Medicine, 2025, 23
ISSN
1741-7015
Publisher
BMC
Journal / Book Title
BMC Medicine
Volume
23
Copyright Statement
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1186/s12916-025-03943-0
Subjects
Early warning score
National early warning score
NEWS2
Accuracy
Sensitivity and specificity
Clinical decision-making
Risk management
Publication Status
Published
Article Number
154
Date Publish Online
2025-03-11