NEWS 2: an opportunity to standardise the management of deterioration and sepsisBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1260 (Published 20 March 2018) Cite this as: BMJ 2018;360:k1260
All rapid responses
Inada-Kim and Nsutebu (1) extol the health system to use the NEWS2 score in all healthcare settings. They state that "a score in one setting must mean the same in any other". The problem is that it doesn't.
Improved communication within health systems is to be encouraged, but as Bernard-Shaw (maybe) commented regarding the UK and USA, primary and secondary care will always be separated by the same language.
In common with any scoring system, diagnostic test or risk stratification tool, the predictive value is governed by the pretest probability as well as the characteristics of the test. A NEWS score of 4 in an emergency medical setting (2) does not mean the same thing in an ambulance call out (3), or in a GP surgery, for the simple reason that serious illness is not as common in these settings to begin with.
Clinicians should do observations on patients and be alert to the sick patient, but we should acknowledge that the NEWS score is not validated in primary care, let alone as a screening tool. Research is needed to establish what any warning score means in primary care, and until then, we need to face the facts that the NEWS score from primary care is spoken with a different dialect.
1. Inada-Kim Matt, Nsutebu Emmanuel. NEWS 2: an opportunity to standardise the management of deterioration and sepsis, BMJ 2018; 360 :k1260
2. Smith et al. 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. D.J. Silcock et al. Validation of the National Early Warning Score in the prehospital setting. Resuscitation 2015;89 31–35
Competing interests: No competing interests