Deteriorating patient and ICU triage

NEWS2 and qSOFA

Reviewed Nov 2026·4 references
New· views rounded down, updated weekly

Early warning scores to detect deterioration and sepsis risk, and how to act on each score band.

Definition
NEWS2 adds points for 7 parameters (RR, SpO2 on scale 1 or 2, air/oxygen, SBP, HR, consciousness incl. new confusion, temperature). qSOFA = RR ≥ 22, altered mentation, SBP ≤ 100 mmHg (1 point each).

At the bedside

  1. 1

    Score every set of observations

    Calculate NEWS2 at every observation round. Use SpO2 Scale 2 (target 88-92%) only for patients with documented hypercapnic respiratory failure, prescribed by a doctor.

  2. 2

    Score 0

    Routine monitoring at least every 12 h.

  3. 3

    Score 1-4

    Nurse informs the registered nurse in charge, who decides on escalation; observations at least every 4-6 h.

  4. 4

    Score 3 in any single parameter

    Low-medium risk: urgent ward-based review by a doctor; observations at least hourly.

  5. 5

    Score 5-6 (key threshold)

    < 30 min

    Medium risk: urgent review within 30 minutes by a clinician competent in acute illness; consider sepsis, start the sepsis screen; observations at least hourly.

  6. 6

    Score ≥ 7

    Immediate

    High risk: emergency assessment by a critical care-competent team (rapid response/ICU outreach), continuous monitoring, consider transfer to HDU/ICU.

  7. 7

    Apply qSOFA in suspected infection

    qSOFA ≥ 2 flags higher risk of death or prolonged ICU stay. Do not use it as the only screening tool for sepsis; a negative qSOFA does not exclude sepsis. Measure SOFA and lactate.

NEWS2 scoring (summary)

Parameter3210123
Resp rate (/min)≤ 8-9-1112-20-21-24≥ 25
SpO2 Scale 1 (%)≤ 9192-9394-95≥ 96---
SpO2 Scale 2 (%)≤ 8384-8586-8788-92 or ≥ 93 on air93-94 on O295-96 on O2≥ 97 on O2
Air or oxygen-Oxygen-Air---
Systolic BP (mmHg)≤ 9091-100101-110111-219--≥ 220
Pulse (/min)≤ 40-41-5051-9091-110111-130≥ 131
Consciousness---Alert--New confusion, V, P or U
Temperature (C)≤ 35.0-35.1-36.036.1-38.038.1-39.0≥ 39.1-

Columns: points scored for low values (left), 0 = normal, points for high values (right).

NEWS2 clinical response

ScoreRiskMonitoringResponse
0Low12-hourlyRoutine
1-4Low4-6 hourlyNurse in charge assesses
3 in one parameterLow-mediumHourlyUrgent ward doctor review
5-6MediumHourlyUrgent review < 30 min, consider sepsis
≥ 7HighContinuousEmergency critical care team review
Red flag · call your senior now
NEWS2 ≥ 7, or new confusion with any infection, is an emergency: same-hour senior/ICU review.
Red flag
qSOFA ≥ 2 with infection: treat as sepsis until proven otherwise; measure lactate and start the hour-1 bundle.
Pitfall
Using SpO2 Scale 2 for every COPD patient. Only use it if hypercapnic failure is documented and a target of 88-92% is prescribed.
Pitfall
Waiting for qSOFA to become positive before treating sepsis. SSC 2026 recommends NEWS, NEWS2, MEWS or SIRS over qSOFA as a single screening tool (strong, moderate certainty).
Pitfall
Scores miss patients on beta-blockers (blunted HR), the elderly, pregnant women (use an obstetric score such as MEOWS) and children.
Pearl
Trend matters more than one number: a NEWS2 rising from 2 to 5 over 6 hours deserves review even below 7.
Pearl
Respiratory rate is the best single predictor; count it for a full 30-60 seconds.

Calculators for this topic

NEWS2

National Early Warning Score 2 (SpO₂ scale 1).

qSOFA

Bedside prompt for poor outcome in suspected infection. Not a diagnostic test for sepsis.

SOFA score

Sequential Organ Failure Assessment: 0-4 per organ system, total 0-24. A rise of ≥ 2 from baseline with infection = sepsis.

References

  1. 1

    Royal College of Physicians. National Early Warning Score (NEWS) 2: standardising the assessment of acute-illness severity in the NHS. London: RCP; 2017.

  2. 2

    Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. 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 2013;84:465-70.

  3. 3

    Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-10.

  4. 4

    Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Intensive Care Med. 2026;52(5):863-936. Co-published in Crit Care Med. 2026 (doi:10.1097/CCM.0000000000007075)

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