NEWS2 is the updated 2017 version of the National Early Warning Score, developed by the Royal College of Physicians (UK) and endorsed by NICE, NHS England, and the World Federation of Societies of Intensive Care. It aggregates six routinely-collected physiological observations into a single number that predicts deterioration, ICU admission, cardiac arrest, and 24-hour mortality.

The 2017 update added two changes: (1) Scale 2 SpO₂ for patients with hypercapnic respiratory failure (target 88–92%) and (2) the ACVPU scale (replacing AVPU) — new-onset Confusion now scores 3 points, recognising delirium as an early sepsis sign.

• Respiratory rate — most sensitive single sign of deterioration
• SpO₂ — using Scale 1 or Scale 2
• Air vs supplemental O₂ — fixed 2 points if on any O₂
• Temperature — both hyper- and hypothermia score
• Systolic BP — hypotension is late but ominous
• Heart rate
• Level of consciousness (ACVPU)

• 0: 12-hourly monitoring.
• 1–4: 4–6 hourly. Inform nurse-in-charge.
• ≥5 OR any single parameter = 3: Hourly. Urgent medical review.
• ≥7: Continuous monitoring. EMERGENCY response, critical care.

NICE Guideline NG51 mandates NEWS2 as part of sepsis screening: a NEWS2 ≥5 with suspected infection triggers the Sepsis-6 bundle within 1 hour (cultures, IV antibiotics, IV crystalloid, serum lactate, urine output, oxygen). The ICMR Standard Treatment Workflow for Sepsis (2022) and the Indian Society of Critical Care Medicine recommend NEWS2 or qSOFA as the front-door screen in ED triage and ward rounds.

Sepsis kills 11 million people globally each year; India contributes ~3 million cases. NEWS2 catches the silent deteriorator hours before qSOFA turns positive.