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Investigation into the predictive capability for mortality and the trigger points of the National Early Warning Score 2 (NEWS2) in emergency department patients
  1. Huw Masson1,
  2. John Stephenson2
  1. 1Emergency Department, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
  2. 2School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
  1. Correspondence to Dr Huw Masson, Emergency Department, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield HD3 3EA, UK; huw.masson{at}


Introduction National Early Warning Score 2 (NEWS2) is widely used to monitor and trigger assessment throughout a patient’s hospital journey. Since the development and role out of NEWS2, its ability to predict mortality has been assessed in several settings, although to date not within an undifferentiated ED population.

Methods We conducted a retrospective observational study of all adult ED attendees at two EDs in Northern England, between March and November 2019. Multilevel multiple logistic regression analyses were conducted on patient episode data to assess the relationship between mortality at 2, 7 and 30 days from attendances; and maximum NEWS2, adjusting for age, sex, arrival mode and triage priority.

Results Data were collected from 91 871 valid patient episodes associated with 64 760 patients. NEWS2 was a significant predictor of mortality at 2 days (OR 1.75; 95% CI 1.58 to 1.93); at 7 days (OR 1.69; 95% CI 1.59 to 1.80); at 30 days (OR 1.58; 95% CI 1.52 to 1.64). For the analyses of categorised NEWS2, NEWS2 of 2–20 was significantly associated with mortality at 2, 7 and 30 days compared with none assigned: OR 3.54 (95% CI 2.15 to 5.85) at 2 days; OR 6.05 (95% CI 3.92 to 9.34) at 7 days; OR 12.4 (95% CI 7.91 to 19.3) at 30 days. Increasing age, male sex, arrival by ambulance and higher triage categories were also associated with significantly increased mortality. Area under the receiver operating characteristic curve values of 0.963, 0.946 and 0.915, respectively, were recorded for mortality outcomes, with optimum likelihood ratios associated with a trigger of 4 NEWS2 points.

Conclusions NEWS2 is an effective predictor of mortality for patients presenting to the ED. Findings suggest that maximum NEWS2 of 4 and over may be the best trigger point for escalation of treatment. Findings also suggest a NEWS2 of 0–1 can identify a very low-risk group within the ED.

  • clinical assessment
  • emergency department
  • triage
  • risk management
  • effectiveness

Data availability statement

No data are available. All data were taken from the Trust EPR system, hence not for public access.

Statistics from

Data availability statement

No data are available. All data were taken from the Trust EPR system, hence not for public access.

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  • Handling editor Kirsty Challen

  • Contributors Both HM and JS contributed equally to this paper. HM planned and sourced the data, authored the paper especially the abstract, introduction and discussion. JS led and performed the statistical analysis, and authored the paper especially the method and results. Both JS and HM reviewed the paper in its entirety. HM submitted the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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