The National Early Warning Score (NEWS2) system has become a cornerstone of clinical practice across the UK, offering a standardised method for early detection of patient deterioration. Developed by the Royal College of Physicians, NEWS2 has been widely implemented in hospitals and healthcare settings since its inception, significantly improving patient outcomes by ensuring timely interventions.

However, the system has limitations. As our population ages and the diversity of patient presentations expands, the need to refine and enhance the predictive capabilities of NEWS2 has become increasingly evident.

What are the current limitations?

While NEWS2 has proven effective, it primarily relies on 'normal' physiological parameters to predict deterioration, such as respiration rate, oxygen saturation, systolic blood pressure, pulse rate, consciousness level, and temperature​. However, these parameters do not always account for individual variations such as age, pre-existing conditions, or trends in vital signs that may indicate a slow but steady decline. Furthermore, NEWS2 is most effective at predicting deterioration within 24 hours, which may not always provide the lead time necessary to intervene effectively in certain patient populations, particularly the elderly.

Refinement of NEWS2

The team led by Dr Chris Plummer, Consultant Cardiologist and Chief Clinical Information Officer at the Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH), Honorary Senior Lecturer at Newcastle University, and Theme Lead for the NIHR Newcastle Biomedical Research Centre, are embarking on a project that aims to improve the accuracy and utility of NEWS2 by incorporating additional patient data and adjusting the scoring process. By utilizing routinely collected demographic, observational, and outcomes data from the Newcastle upon Tyne Hospitals NHS Foundation Trust, the research seeks to identify new variables or alternative weightings that could enhance the system’s predictive power.

A recent scoping review has provided valuable insights, highlighting promising avenues for modification. Key findings suggest that incorporating age as a variable, tracking trends in vital signs over time, and transforming the inspired oxygen fraction (FiO2) from a binary input to a weighted variable could significantly improve the accuracy of NEWS2​. These modifications could better capture the nuances of patient deterioration, particularly in older adults, who may present with atypical symptoms.

Next steps and call for collaboration

The team are currently in the process of exporting Electronic Health Records (EHR) data to begin developing and testing a created algorithm. This proof-of-concept model will serve as the foundation for a more refined version of NEWS2, with the potential to be rolled out across the NHS and beyond.

They are keen to collaborate with other NHS Trusts and international health service providers who share the commitment to improving patient outcomes. Here are several ways to get involved:

Knowledge Pooling: early outreach has identified several groups pursuing similar objectives and indicates interest in a forum to network, share experiences and create synergies. If you are interested in joining such a forum, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..

Algorithm Development: If your group has developed an algorithm aligned with the objectives and you would like to discuss access to the dataset for validation and refinement, please get in touch.

Data Sharing: If you have a dataset that may be suitable for the validation and refinement stages of the investigations, please get in touch.

General Inquiries: For any other interests or inquiries, please contact This email address is being protected from spambots. You need JavaScript enabled to view it.