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Hunt and Hess Scale for Subarachnoid Haemorrhage

Clinical grading of aneurysmal subarachnoid haemorrhage.

For healthcare professionalsNeurologyv1.0.1

For healthcare professionals / clinical use. Not a self-diagnosis tool.

Your measurements

Grade

Calculated on your device. Nothing is sent to a server.

Your result will appear here

Enter your measurements, then press Calculate.

Methodology

Hunt and Hess (1968)

Grade 1–5 by clinical description

Originally devised to estimate surgical risk; the WFNS scale (GCS-based) is an alternative.

Who it is for
Adults with aneurysmal subarachnoid haemorrhage.
Version
1.0.1

How this calculator works

Where the formula comes from

  • Hunt and Hess (1968) graded patients in a study of surgical risk in relation to the timing of intracranial aneurysm repair.[1]

Versions and alternatives

  • A World Federation of Neurosurgical Societies committee proposed a universal subarachnoid haemorrhage grading scale in 1988.[2]

Where accuracy falls (published evidence)

  • In 103 paired assessments, interobserver agreement was lowest for Hunt and Hess (weighted kappa 0.48) compared with the WFNS (0.60) and PAASH (0.64) scales.[3]

Sources

  1. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14–20. doi:10.3171/jns.1968.28.1.0014
  2. Teasdale GM, Drake CG, Hunt W, et al. A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry. 1988;51(11):1457. doi:10.1136/jnnp.51.11.1457
  3. Degen LA, Dorhout Mees SM, Algra A, Rinkel GJ. Interobserver variability of grading scales for aneurysmal subarachnoid hemorrhage. Stroke. 2011;42(6):1546–1549. doi:10.1161/STROKEAHA.110.601211

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on

Worked example: how to calculate hunt and Hess

Inputs

Grade
2 — Moderate to severe headache, nuchal rigidity, no neurological deficit other than cranial nerve palsy

Result

Hunt and Hess grade
2

Moderate to severe headache, nuchal rigidity, no neurological deficit other than cranial nerve palsy

An illustration with sample values, worked out with the same method the tool above uses.

Limitations

  • Subjective descriptors; serious systemic disease traditionally adds one grade.
  • Interobserver agreement was lower than for the WFNS and PAASH scales in a 2011 study (Degen 2011).

References

  1. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14–20. doi:10.3171/jns.1968.28.1.0014
  2. Teasdale GM, Drake CG, Hunt W, et al. A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry. 1988;51(11):1457. doi:10.1136/jnnp.51.11.1457
  3. Degen LA, Dorhout Mees SM, Algra A, Rinkel GJ. Interobserver variability of grading scales for aneurysmal subarachnoid hemorrhage. Stroke. 2011;42(6):1546–1549. doi:10.1161/STROKEAHA.110.601211

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