Association of initial national early warning score with clinical deterioration in pulmonary embolism

Thrombosis Journal

Table 1 National early warning score (NEWS2) in patients with pulmonary embolism*

Predictors	Points
Predictors	3	2	1	0	1	2	3
Systolic blood pressure, mmHg	≤ 90	91–100	101–110	111–219			≥ 220
Heart rate, beats per minute	≤ 40		41–50	51–90	91–110	111–130	≥ 131
Respiratory rate, breaths per minute	≤ 8		9–11	12–20		21–24	≥ 25
Temperature, ^oFahrenheit	≤ 95		95.1–96.8	96.9–100.4	100.5–102.2	≥ 102.3
Supplemental oxygen use?		Yes		No (room air)
Level of Consciousness **				Alert (GCS = 15)			Altered: New-onset confusion (or disorientation/agitation), or responds to verbal voice commands, or responds to pain (localizes, withdraws, or opens eyes), or unresponsive (GCS = 3)
Hypercapnic Respiratory Failure: If No, *useScale 1*; if Yes, useScale 2**
Scale 1: Oxygen saturation by pulse oximetry,	≤ 91%	92–93%	94–95%	≥ 96%
Scale 2: Oxygen saturation by pulse oximetry	≤ 83%	84–85%	86–87%	88–92%, ≥ 93% on room air	93–94% on supple-mental oxygen	95–96% on supple-mental oxygen	≥ 97% on supplemental oxygen

Abbreviations: GCS = Glasgow Coma Scale
* A report by the Royal College of Physicians recommends using NEWS to influence the
following four features of subsequent clinical care: urgency of the response, skills and
experience of the responders, clinical monitoring frequency, and hospital setting selected for
ongoing care [1].
** We classified Level of Consciousness using Alert (0 points) or Altered (3 points [verbal, pain,
and unresponsive]) based on components of the Glasgow Coma Scale (GCS). To distinguish
‘Alert’ versus ‘Altered’ for level of consciousness: Select ‘Alert’ if GCS was 15; select
‘Altered’ if GCS was not 15 but the patient was altered in some way with the following
responses to verbal or pain stimuli:
1) Verbal: Select if the patient responded to verbal commands
2) Pain: Select if the patient localized pain, withdrew from pain, or if eye opening was in
response to pain (GCS not 15)
3) Unresponsive: Select if GCS was 3

ISSN: 1477-9560