National Early Warning Score (NEWS) Calculator

How does this National Early Warning Score (NEWS) calculator work?

This is a health tool that evaluates the severity of the patient’s condition and the likelihood of transfer to the intensive care unit for more specialized care.

This National Early Warning Score (NEWS) calculator is based on the early warning signs scoring system that assesses physiological bedside parameters in order to provide information on the care outcome in the patient’s case, especially in regard to the need for transfer to the intensive care unit:

■ Respiratory rate is taken in consideration in assessing the level of distress on the pulmonary system and on the central nervous system areas regulating breathing. It counts the breaths per minute and ranges between under 8 to over 25.

■ Oxygen saturation and whether the patient is in need for oxygen supplementation are also reviewed in this severity assessment, with levels under 91 to above 96 becoming increasingly problematic and urging for more specialized care.

■ Body temperature is also monitored and the calculator displays it both in Celsius and Fahrenheit for convenience. Different scores are given to the different temperature categories in the EWSS.

■ Systolic blood pressure and heart rate offer information on the hearts travail as well as on the circulation of the blood throughout the arteries and veins. Systolic BP ranges between below 90 and above 220 while the number of beats per minute is situated between under 40 to over 131.

■ AVPU score monitors the level of consciousness assessed with the AVPU procedure. The results are placed under alert or under the responsive to voice, responsive to pain or unresponsive.

Another guideline to be followed while completing the assessment suggests that when a parameters is under a category that weighs 3 points, that parameter needs further monitoring, regardless of the lower scores in other parameters.

This model standardizes the clinical assessment of ill patients that might require critical care intervention and comes as a derivation from other systems. However, it is considered to be more specific and sensitive than the previous versions although it is not recommended to be used in patients under 16 years of age.

The general guideline says that in patients with lower scores should be continued the standard observation procedure while in patient with high scores, further additional monitoring is required as well as the likelihood of the patient being moved in the critical care unit. It is not an evaluation to be used in admission only such as the Injury severity score but rather the patients should be frequently reassessed, sometimes based on the previous scores or based on the changes in standard physiological parameters.

There is also in use another version of the early warning scoring system, the MEWS model that puts more focus on the main parameters.

NEWS interpretation

The scoring system is evaluated by adding the points obtained in each of the seven criteria in the early warning system. The answer choices weigh from 0 to 3 points, according to the severity of the conditions and the likelihood of them being a factor in the overall outcome of the patient needing intensive care unit supervision. The meaning carried by the score categories is explained below:

■ 0 – 4: This is a low score that suggests clinical monitoring should be continued and the medical professional, usually a registered nurse will decide further if clinical care needs to be updated.

■ 5 – 6: This is a medium score that suggests the patient should be reviewed by a medical specialist with competencies in acute illness, even with the possibility of referring the patient to the critical care unit at the end of the assessment.

■ 7 or above: This is a high score (red score) that is indicative of urgent critical care need and the patient should be transferred to the appropriate specialized department for further care.

References

1) Royal College of Physicians. National Early Warning Score (NEWS) Standardizing the assessment of acute-illness severity in the NHS. Report of a working party. London: RCP, 2012.

2) McGinley A, Pearse RM. (2012) A national early warning score for acutely ill patients. BMJ; 345:e5310.

3) Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. (2013) The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation; 84(4):465-70.

4) Alam N, Hobbelink EL, van Tienhoven AJ, van de Ven PM, Jansma EP, Nanayakkara PW. (2014) The impact of the use of the Early Warning Score (EWS) on patient outcomes: a systematic review. Resuscitation; 85(5):587-94

5) Smith ME, Chiovaro JC, O'Neil M, Kansagara D, Quiñones AR, Freeman M, Motu'apuaka ML, Slatore CG. (2014) Early warning system scores for clinical deterioration in hospitalized patients: a systematic review. Ann Am Thorac Soc; 11(9):1454-65.