Recommendation 10: NEWS2 should be used to monitor all acutely ill adult patients in prehospital, emergency department, acute hospital and community settings.

The majority of NHS boards across Scotland use NEWS2 as their observation system in the acute setting. It is increasingly used in both prehospital and community settings. Any observation system should be used as an aid to clinical assessment and can never fully replace clinical judgement or concern.

A systematic review that included seven studies in the prehospital setting and 13 in the emergency department setting was inconclusive in favouring any one scoring system over another in either patient setting.¹⁶ In prehospital settings NEWS2 and NEWS (when applied at high thresholds) were comparable in identifying short-term (3 days) mortality but could not predict 30-day mortality. In addition, the predictive ability of these scores did not progressively increase in a consistent manner when increasing thresholds were applied. Although NEWS2 and NEWS were comparable in predicting 30-day mortality in emergency department settings, no clear thresholds were identified.

There were no comparator studies in the community or inpatient healthcare setting.

Scoring systems require healthcare professionals to be familiar with their application and meaning. In the absence of clear superiority of one scoring system over another, maintaining the status quo will maintain familiarity with, and reduce the need for, new training and embedding of learning. Universal adoption of a single scoring system across prehospital, community and secondary care settings may reduce variance and help with training and embedding into practice. Over-reliance on early warning scores to predict deterioration may falsely reassure clinicians or fail to identify at-risk patients.