Hunt-Hess Scale (SAH) — Free Online Calculator
Clinical Presentation
Hunt-Hess Grade
1
Good prognosis with surgical intervention
About This Calculator
The Hunt and Hess Scale classifies the severity of subarachnoid hemorrhage (SAH) based on clinical presentation. It is used to assess patient condition at presentation, guide surgical timing decisions, and predict prognosis. Higher grades are associated with greater vasospasm risk, higher surgical mortality, and worse overall outcomes. The scale is widely used alongside the World Federation of Neurological Surgeons (WFNS) SAH grading system.
Formula
Interpretation
| Grade | Surgical Mortality | Prognosis |
|---|---|---|
| 1 | ~1% | Good |
| 2 | ~5% | Good |
| 3 | ~19% | Guarded |
| 4 | ~42% | Poor |
| 5 | ~77% | Very poor |
References
Frequently Asked Questions
What is the difference between Hunt-Hess and Fisher grading?
Hunt-Hess grades clinical severity based on symptoms and neurological exam, while the Fisher scale grades the amount and distribution of blood on CT imaging. Both are used together: Hunt-Hess predicts overall outcome, and Fisher predicts vasospasm risk.
Does Hunt-Hess grade affect treatment decisions?
Yes. Grades 1–3 are generally treated with early surgical clipping or endovascular coiling. Grade 4–5 patients present a dilemma — outcomes are poor regardless, but some centers still offer early intervention. The timing and approach depend on individual patient factors.
Can the Hunt-Hess grade change over time?
Yes. The grade at presentation is most commonly used, but patients can deteriorate (rebleeding, vasospasm, hydrocephalus) or improve. Serial assessment is important, as clinical status at the time of intervention influences surgical risk.
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⚠ Medical Disclaimer
This tool is for educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional for clinical decisions.