Digital heart monitor with a question mark, symbolizing uncertainty in patient monitoring.

NEWS2: Is This Early Warning System Safe Enough for Your Loved Ones?

"A critical look at the National Early Warning Score 2 (NEWS2) and its potential impact on patient safety, especially for those with respiratory issues."


The National Early Warning Score (NEWS) has become a standard tool in hospitals for identifying patients at risk of deterioration. It's designed to be a simple, standardized system, allowing healthcare providers to quickly assess a patient's condition and respond accordingly. However, concerns have been raised about its effectiveness in patients with chronic respiratory conditions, leading to the development of NEWS2.

NEWS2 was created with the intention of improving safety for patients with hypercapnic respiratory failure, a condition where there's too much carbon dioxide in the blood. The Royal College of Physicians (RCP) proposed NEWS2, suggesting a separate oxygen saturation (SpO2) parameter scoring system for these patients. But does this adjusted system truly offer a better approach?

A study examining patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) questioned whether NEWS2 outperformed the original NEWS. This article will explore the potential pitfalls of NEWS2, particularly the risk of assigning lower risk scores to seriously ill patients, and why prospective research is crucial before widespread implementation.

The Potential Risks of NEWS2: A Closer Look

Digital heart monitor with a question mark, symbolizing uncertainty in patient monitoring.

The core issue lies in how NEWS2 adjusts the SpO2 parameters for patients with hypercapnic respiratory failure. While the intention is to avoid over-alerting, the study reveals a concerning possibility: patients who would have been flagged as high-risk (NEWS ≥7) under the original NEWS could be reclassified as lower risk under NEWS2. This could lead to delayed interventions and potentially adverse outcomes.

Consider a scenario where a patient with AECOPD scores a 7 or higher on the original NEWS, indicating a need for urgent attention. Under NEWS2, because of the adjusted SpO2 scoring, their score might drop below 7, placing them in a lower call-out threshold. The study found that this would have happened to 44% of patients who scored ≥7 on the original NEWS and subsequently died.

  • Decreased Sensitivity: NEWS2 may fail to identify high-risk patients who truly need immediate intervention.
  • Compromised Standardisation: The unified approach of the original NEWS is lost, potentially creating confusion and inconsistencies in patient assessment.
  • Potential for Delayed Care: Lower call-out thresholds could lead to less frequent monitoring and delayed escalation of care for deteriorating patients.
The researchers argue that while NEWS2 might reduce 'false alarms,' it's not without clinical risk. The benefit of a standardized scoring system, where all patients are assessed using the same criteria, is undermined. Introducing different scoring systems for subsets of patients can be counter-intuitive and potentially dangerous.

The Path Forward: Research and Prudent Implementation

The authors of the study emphasize the need for prospective research before widespread implementation of NEWS2. A large national dataset should be utilized to determine the best parameters for predicting mortality and clinical deterioration in patients with hypercapnic respiratory failure.

Key questions to address include:

<ul> <li>What are the optimal parameters for predicting adverse outcomes in patients with hypercapnic respiratory failure?</li> <li>Should lower SpO2 weighting be applied to all COPD admissions, or only to a specific subgroup?</li> <li>What are the best parameters to predict mortality for patients with AECOPD without hypercapnic respiratory failure?</li> </ul>

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.7861/clinmedicine.18-5-371, Alternate LINK

Title: News 2 – Too Little Evidence To Implement?

Subject: General Medicine

Journal: Clinical Medicine

Publisher: Royal College of Physicians

Authors: Luke E Hodgson, Jo Congleton, Richard Venn, Lui G Forni, Paul J Roderick

Published: 2018-10-01

Everything You Need To Know

1

What is the National Early Warning Score 2 (NEWS2)?

The National Early Warning Score 2 (NEWS2) is a system designed to assess a patient's condition and identify those at risk of deterioration. It's an updated version of the original National Early Warning Score (NEWS), intending to improve patient safety. The Royal College of Physicians (RCP) proposed NEWS2, adjusting the scoring system, specifically the oxygen saturation (SpO2) parameter, for patients with hypercapnic respiratory failure. However, its effectiveness is currently under scrutiny, questioning whether NEWS2 is an improvement over the original NEWS.

2

Why is NEWS2 important, and what are its implications?

NEWS2 is important because it aims to enhance patient safety by providing a standardized method for assessing patient deterioration. Healthcare providers can quickly evaluate a patient's condition and respond appropriately using this system. The goal is to enable timely interventions. However, the significance lies in its potential pitfalls, specifically concerning how it adjusts the SpO2 parameters for those with hypercapnic respiratory failure. The implications are substantial because adjustments could lead to delayed interventions and adverse outcomes. Research suggests that the adjusted system may not be as effective as anticipated and could compromise patient safety.

3

What is hypercapnic respiratory failure, and how does it relate to NEWS2?

Hypercapnic respiratory failure is a condition where there is too much carbon dioxide in the blood. NEWS2 was created with these patients in mind, aiming to improve safety for those with this specific condition. The RCP proposed NEWS2 with a modified oxygen saturation (SpO2) parameter scoring system specifically for these patients. The implications are that, while the intention is to avoid over-alerting, NEWS2 may inadvertently mask the severity of the condition, potentially leading to delayed care and adverse outcomes. The adjusted SpO2 scoring is a key consideration when assessing patients with hypercapnic respiratory failure using NEWS2.

4

What are the potential risks associated with using NEWS2?

The study highlights that NEWS2 might assign lower risk scores to seriously ill patients, particularly those with conditions like acute exacerbations of chronic obstructive pulmonary disease (AECOPD). A critical issue is that patients who would have been identified as high-risk (NEWS ≥7) under the original NEWS might be reclassified as lower risk under NEWS2 due to the adjusted SpO2 parameters. This reclassification can lead to decreased sensitivity, potential delays in care, and adverse outcomes. The core issue is the potential for delayed interventions and the compromise of a standardized approach to patient assessment.

5

What steps should be taken before widespread implementation of NEWS2?

The path forward involves conducting prospective research before implementing NEWS2 widely. It is crucial to determine the best parameters for predicting mortality and clinical deterioration in patients with hypercapnic respiratory failure. This research should ideally use a large national dataset. This will help to validate the system. It's essential to weigh the potential benefits of reducing 'false alarms' against the risks of delayed interventions and the loss of standardization. Prudent implementation, based on thorough research, is vital to ensure patient safety and prevent unintended consequences of the NEWS2 system.

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