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Hunt & Hess Scale — Subarachnoid Haemorrhage
Clinical grading of SAH severity to predict surgical risk and mortality
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30-Day Mortality
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Surgical Risk
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WFNS Equivalent
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Clinical Action
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Hunt & Hess Reference Table
| Grade | Clinical Description | Mortality | Surgical Risk |
|---|---|---|---|
| 0 | Unruptured aneurysm | Minimal | Low |
| 1 | Mild headache, slight nuchal rigidity | ~5% | Good candidate |
| 2 | Severe headache, nuchal rigidity, no deficit | ~10% | Good candidate |
| 3 | Drowsiness, confusion, mild focal deficit | ~30% | Higher risk |
| 4 | Stupor, hemiparesis, early decerebrate posturing | ~40% | High risk |
| 5 | Deep coma, decerebrate posturing | 50–80% | Very high risk |
Hunt & Hess Grade based on clinical presentation at time of assessment
Higher grades correlate with higher vasospasm risk, poorer outcomes
Higher grades correlate with higher vasospasm risk, poorer outcomes
Management: Grades 1–2: Early surgical clipping or endovascular coiling recommended within 24–72h. Grades 3–4: Stabilise medically; surgery when condition improves. Grade 5: Supportive care; surgery highly controversial. All grades: nimodipine 60mg q4h for vasospasm prophylaxis.
For clinical decision support only. Not a substitute for professional medical judgment.
