The United Kingdom’s National Early Warning Score: should everyone use it? A narrative review

Abstract

This review critiques the benefits and drawbacks of the United Kingdom’s National Early Warning Score (NEWS). Potential developments for the future are considered, as well as the role for NEWS in an emergency department (ED). The ability of NEWS to predict death within 24 h has been well validated in multiple clinical settings. It provides a common language for the assessment of clinical severity and can be used to trigger clinical interventions. However, it should not be used as the only metric for risk stratification as its ability to predict mortality beyond 24 h is not reliable and greatly influenced by other factors. The main drawbacks of NEWS are that measuring it requires trained professionals, it is time consuming and prone to calculation error. NEWS is recommended for use in acute UK hospitals, where it is linked to an escalation policy that reflects postgraduate experience; patients with lower NEWS are first assessed by a junior clinician and those with higher scores by more senior staff. This policy was based on expert opinion that did not consider workload implications. Nevertheless, its implementation has been shown to improve the efficient recording of vital signs. How and who should respond to different NEWS levels is uncertain and may vary according to the clinical setting and resources available. In the ED, simple triage scores which are quicker and easier to use may be more appropriate determinants of acuity. However, any alternative to NEWS should be easier and cheaper to use and provide evidence of outcome improvement.

Predicting acute clinical deterioration with interpretable machine learning to support emergency care decision making

“…Table 3 draws comparisons with NEWS2 by fixing the models’ sensitivity at three levels (0.602, 0.396, and 0.220) that match the observed sensitivity of NEWS2 in this cohort at cutoffs 3, 5, and 7, respectively. We focus on the NEWS2 cutoff of points for triggering an emergency response, that is often adopted instead of the stricter recommended threshold of points 35 . At this operating point, LightGBM yields a PPV of 0.638, meaning we expect of patients the model deems high risk will deteriorate within 24 hours, compared to of patients occupying this NEWS2 threshold.…”

Treatment and Care for Nursing Home Residents with COVID-19: A Qualitative Study

“…NEWS 36 is a tool developed to detect early declines in patients’ health and a validated tool for hospital use. 37 It played an effective role in identifying COVID-19 deterioration in hospitalized patients. 38 , 39 …”

Applying Early Warning Score (EWS) in hospitals for adult mortality risk factors

“…The Early Warning Score should not be used as the only tool because its ability to predict death after 24 hours is unreliable and is strongly influenced by other factors (Holland & Kellett, 2023). Digital technology needs to be considered to help optimize EWS because it can monitor patients remotely and facilitate communication between health professionals (Bell et al, 2021;Eddahchouri et al, 2022;Schmidt et al, 2015).…”