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
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.
