We agree with Smith et al. [1] who point out the confusion that surrounds the nomenclature of the various early warning scoring systems that are used throughout the world. We specifically published this paper in an Irish Journal realizing that the “NEWS” (National Early Warning Score) which is applied in Ireland is an adaptation of the VitalPAC early warning score which was outlined in our introduction [2]. Thus, we wholeheartedly concur that studies of “NEWS” in the UK cannot necessarily be compared directly with those from Ireland. The authors of this paper, who carry no conflict of interest pertaining to the Irish NEWS scoring system, merely set out to describe the performance of the tool which is used in Ireland.

The valid message from our study emphasizes that the “NEWS” which is applied in Ireland does not perform well in Model 2 hospitals where populations are enriched with oxygen-dependent patients with pulmonary disease. This fact is also supported by other investigators where early warning scoring systems with similar titles are used in other jurisdictions [3–5].