NPEWS Scoring — clinical narrative¶

The numbers live elsewhere. The single source of truth for every numeric threshold is npews-scoring-spec.json. It generates both the runtime bands (chart/npews-scoring-config.js) and the human-readable npews-scoring-tables.generated.md; a test fails if they drift. Edit the JSON, then run npm run generate:scoring.

This file holds only the clinical narrative that the JSON can't express — the per-age-band respiratory-distress descriptors below. For the RR / HR / BP / SpO₂ / oxygen / capillary-refill thresholds, the oxygen-device rule and the escalation mapping, see the generated reference table.

Source: Configuration Document for SPOT NPEWS (NHS England). Scores are colour-coded White (0), Yellow (1), Orange (2), Pink (4).

Conformance note. Temperature and AVPU are not numerically scored. Temperature produces a “Think sepsis” warning without independently assigning an escalation level; AVPU produces a specific-concern escalation decision, matching the national SPOT NPEWS algorithm. See escalation.md.

Clinical verification. The numeric thresholds in the source JSON were manually checked against the live NHS England NPEWS charts by Marcus Baw (GMC 4712729) on 2026-06-30.

Respiratory distress descriptors¶

Respiratory distress is scored Mild = 1 (Yellow), Moderate = 2 (Orange), Severe = 4 (Pink). The clinical signs for each severity differ between the younger and older age groups.

0–11 months and 1–4 years¶

Severity	Signs
Mild (1)	Nasal flaring; subcostal recession
Moderate (2)	Head bobbing; tracheal tug; intercostal recession; inspiratory or expiratory noises
Severe (4)	Sternal recession; grunting; exhaustion; impending respiratory arrest

5–12 years and 13–18 years¶

Severity	Signs
Mild (1)	Accessory muscle use
Moderate (2)	Tracheal tug; intercostal recession; inspiratory or expiratory noises
Severe (4)	Tripoding; supraclavicular recession; grunting; exhaustion; impending respiratory arrest

Implementer notes¶

Oxygen support device overrides delivery-level scoring: High Flow (HF), BiPAP (BiP) and CPAP (CP) always score 4; nasal prongs (NP), face mask (FM), head box (HB) and non-rebreather (NRB) score per the oxygen-delivery band. (Full rule and the numeric oxygen bands are in the generated table.)
Very low oxygen support: if a system permits recording FiO₂ below the lowest banded value (or < 0.01 L/min) while support is being given, it should still score 1.
Capillary refill: the charts define ≤ 2 s = 0 and ≥ 3 s = 2, with no score defined for the 2.01–2.99 s gap.