Hunt and Hess Scale for Subarachnoid Hemorrhage (SAH)

It classifies current clinical presentation in aneurysmal subarachnoid hemorrhage using five ordinal grades, I–V. It is not a diagnostic test or arithmetic score.

Sources: [1, 2]

A 2024 study proposed keeping traditional grades 1–3, defining modified grade 4 as traditional grade 4 plus traditional grade 5 with GCS 6–8, and limiting modified grade 5 to traditional grade 5 with GCS 3–5. This calculator does not run that proposed model; it selects only the traditional five-grade scale.

Sources: [9]

No. It describes presentation after clinical assessment; CT, CTA, DSA and other appropriate evaluation establish diagnosis.

Sources: [3]

Record a stated assessment time, commonly first or admission assessment, with the actual examination state. Do not present a later grade as the admission grade.

Sources: [1, 4]

Yes. Clinical status can change with rebleeding, hydrocephalus, delayed cerebral ischemia or treatment; record timing and comparability factors with serial grades.

Sources: [3]

Sedation, intubation, paralytic medication and postictal state can confound examination and must be documented alongside other reversible factors; this page does not correct a grade automatically.

Sources: [4, 5]

No. Higher grades have historically been associated with worse cohort outcomes, but this page does not provide a fixed individual mortality percentage because patient, aneurysm, hemorrhage, complication, treatment-era and care-setting factors vary.

Sources: [1, 3]

No. It cannot independently decide clipping, coiling or treatment timing. Decisions require imaging, aneurysm features, timing, confounders and neurovascular-team assessment.

Sources: [3]

Hunt–Hess is a clinical-presentation classification; WFNS primarily uses GCS and major focal deficit. They answer related but different questions and are not interchangeable.

Sources: [7, 8]

Fisher and modified Fisher describe CT blood burden and distribution, while Hunt–Hess describes clinical presentation. Neither replaces the other.

Sources: [4]

The scale has subjective elements and observer variability, particularly when examination findings are affected by confounders. Standardized documentation improves communication.

Sources: [5, 6]

It is primarily used in aneurysmal SAH. Other causes require interpretation under the applicable clinical protocol rather than automatic use of this scale.

Sources: [1, 3]