Riccalton Victoria, Threlfall Lynsey, Ananthakrishnan Ananya, Cong Cen, Milne-Ives Madison, Le Roux Peta, Plummer Chris, Meinert Edward
Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK.
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
BMC Med. 2025 Mar 11;23(1):154. doi: 10.1186/s12916-025-03943-0.
The National Early Warning Score 2 (NEWS2) has been adopted as the standard approach for early detection of deterioration in clinical settings in the UK, and is also used in many non-UK settings. Limitations have been identified, including a reliance on 'normal' physiological parameters without accounting for individual variation.
This review aimed to map how the NEWS2 has been modified to improve its predictive accuracy while placing minimal additional burden on clinical teams.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) and the Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks were followed to structure the review. Six databases (CINAHL, PubMed, Embase, ScienceDirect, Cochrane Library and Web of Science) were searched for studies which reported the predictive accuracy of a modified version of NEWS2. The references were screened based on keywords using EndNote 21. Title, abstract and full-text screening were performed by 2 reviewers independently in Rayyan. Data was extracted into a pre-established form and synthesised in a descriptive analysis.
Twelve studies were included from 12,867 references. In 11 cases, modified versions of NEWS2 demonstrated higher predictive accuracy for at least one outcome. Modifications that incorporated demographic variables, trend data and adjustments to the weighting of the score's components were found to be particularly conducive to enhancing the predictive accuracy of NEWS2.
Three key modifications to NEWS2-incorporating age, nuanced treatment of FiO data and trend analysis-have the potential to improve predictive accuracy without adding to clinician burden. Future research should validate these modifications and explore their composite impact to enable substantial improvements to the performance of NEWS2.
英国已采用国家早期预警评分2（NEWS2）作为临床环境中早期发现病情恶化的标准方法，许多非英国的环境也在使用。已发现其存在局限性，包括依赖“正常”生理参数而未考虑个体差异。
本综述旨在梳理NEWS2是如何被修改以提高其预测准确性，同时将对临床团队的额外负担降至最低。
遵循系统评价和Meta分析的首选报告项目（PRISMA-ScR）以及人群、干预措施、对照、结局和研究（PICOS）框架来构建综述。检索了六个数据库（CINAHL、PubMed、Embase、ScienceDirect、Cochrane图书馆和科学网），以查找报告NEWS2修改版本预测准确性的研究。使用EndNote 21基于关键词筛选参考文献。两名评审员在Rayyan中独立进行标题、摘要和全文筛选。数据被提取到预先建立的表格中，并进行描述性分析综合。
从12867篇参考文献中纳入了12项研究。在11个案例中，NEWS2的修改版本对至少一项结局显示出更高的预测准确性。发现纳入人口统计学变量、趋势数据以及对评分组成部分权重的调整等修改特别有助于提高NEWS2的预测准确性。
对NEWS2的三项关键修改——纳入年龄、对FiO₂数据进行细微处理以及趋势分析——有可能在不增加临床医生负担的情况下提高预测准确性。未来的研究应验证这些修改并探索其综合影响，以使NEWS2的性能得到实质性改善。
