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

Mark Holland*, John Kellett

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


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.

Original languageEnglish
JournalInternal and Emergency Medicine
Issue number2
Pages (from-to)573-583
Publication statusPublished - Mar 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).


  • Early warning scores
  • Escalation protocols
  • Rapid response systems
  • Triage
  • Emergency Service, Hospital
  • Risk Assessment
  • Hospital Mortality
  • Humans
  • United Kingdom
  • ROC Curve
  • Retrospective Studies
  • Early Warning Score


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