Intended for healthcare professionals

Letters NEWS 2 and sepsis

NEWS 2 sepsis score is not validated in primary care

BMJ 2018; 361 doi: (Published 23 April 2018) Cite this as: BMJ 2018;361:k1743
  1. Alex Burns, general practitioner
  1. Acute GP Service, Treliske Hospital, Truro TR1 3LQ, UK
  1. alex.burns{at}

Inada-Kim and Nsutebu urge the health system to use the NEWS 2 score in all healthcare settings.1 They say that “a score in one setting must mean the same in any other.” The problem is that it doesn’t.

Improved communication in health systems should be encouraged, but as Bernard Shaw (maybe) said about the United Kingdom and United States, primary and secondary care will always be separated by the same language.

As with any scoring system, diagnostic test, or risk stratification tool, the predictive value is governed by the pre-test probability as well as the characteristics of the test. A NEWS score of 4 in an emergency medical setting2 does not mean the same as in an ambulance call-out3 or a GP surgery, for the simple reason that serious illness is not as common in these settings.

Clinicians should observe patients and be alert to sickness, but we should acknowledge that the NEWS score is not validated in primary care, let alone as a screening tool. We need research to establish what any warning score means in primary care; until then, we must accept that the NEWS score from primary care is spoken with a different dialect.


  • Competing interests: None declared.