NEWS2 calculation and the escalation response

Score each parameter in turn. Respiratory rate 22 scores 2 (21 to 24). Oxygen saturation 94 percent on air, using scale 1, scores 1 (94 to 95). Supplemental oxygen: air scores 0. Systolic blood pressure 104 scores 1 (101 to 110). Pulse 102 scores 1 (91 to 110). Conscious level: alert scores 0. Temperature 38.2 scores 1 (38.1 to 39.0). The aggregate NEWS2 is 2 plus 1 plus 0 plus 1 plus 1 plus 0 plus 1, which is 6.^[1]

A NEWS2 of 5 to 6 is the key escalation threshold. It mandates an urgent review by a clinician with competencies in the assessment of acute illness and an active consideration of a critical-care referral, with an increase in the frequency of observations. This is not a low-risk observation patient: he is at the threshold at which escalation is clearly indicated.^[1]

^[3]The clinical context is sepsis from a respiratory source. The response runs in parallel with the escalation: a structured ABCDE assessment, oxygen titrated to target, intravenous access with bloods including lactate and cultures, early broad-spectrum antibiotics within the first hour, a balanced crystalloid bolus for the relative hypotension and tachycardia with reassessment, and serial early-warning scoring. The lactate and the trend determine whether this becomes a critical-care admission. The score triggered the review; the review must trigger the bundle.