Does the use of National Early Warning Scores (NEWS or NEWS2) in healthcare settings improve patient outcomes: a systematic review

Background:
The National Early Warning Score (NEWS), and updated NEWS2, is used to detect all-cause deterioration, based on clinical observations. Many studies have validated the prognostic accuracy of NEWS/NEWS2, but few have investigated whether its use improves patient outcomes. This systematic review aims to bring together all evidence evaluating the effectiveness of using NEWS/NEWS2, compared to not using NEWS/NEWS2, on patient outcomes.

Methods:
We searched Embase, MEDLINE, CINAHL, The Cochrane Library, and international trial registries from January 2012 (when NEWS was developed) to October 2024, for all records which mentioned NEWS/NEWS2 in their title or abstract. All comparative studies with interventions which included NEWS/NEWS2, and comparator areas, regions, organisations, time points, or settings which did not, were included. The target population was all non-maternity patients aged 16+ years treated in healthcare settings. Where possible, studies were synthesised by outcome using random-effects meta-analyses. Risk of bias was assessed using ROB2 and ROBINS-I v2; certainty of evidence was assessed using GRADE. PROSPERO registration CRD42023442061.

Results:
We screened 2814 records and included 20 studies (in 32 records), with 18 presenting data for our outcomes. Sample sizes ranged from 66 to 13,059,865 participants. There was low certainty evidence that using NEWS/NEWS2 reduced in-hospital mortality (summary odds ratio [OR] from eleven studies 0.79, 95% confidence interval [CI] 0.66 to 0.94). There was also a little low certainty evidence of a reduction in hospital length of stay (two of four studies) and cardiac arrests (three of seven studies), and a potential reduction in intensive care admissions (summary OR from seven studies 0.63, 95% CI 0.36 to 1.09). Most included studies had a serious/high (12/18; 67%) or moderate (5/18; 28%) risk of bias.

Conclusions:
This review highlights a lack of large scale, high-quality studies exploring the effectiveness of NEWS/NEWS2. No included studies reported negative clinical impacts of using NEWS/NEWS2 on any outcomes presented in this review. However, there is still further work required to ascertain whether the use of NEWS/NEWS2 improves patient outcomes.