Test to risk-stratify patients with subarachnoid hemorrhages.

  1. Asymptomatic, mild headache, ± slight nuchal rigidity
  2. Moderate - severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy
  3. Drowsiness or confusion, mild focal neurologic deficit
  4. Stupor, moderate - severe hemiparesis
  5. Coma, decerebrate posturing

 

Higher score indicates higher morbidity and mortality. Score does not affect disposition or ED clinical course, but is useful for framing the conversation with consultants (Fisher grade is also useful for the consultants).

 

Hunt, WE and Hess, RM. Surgical risk as related to time of intervention in the repair of intracranial aneurisms. J of Neurosurg. 1968. 28(1): 14-20.

Degen, LAR et al. Interobserver variability of grading scales for aneurysmal subarachnoid hemorrhage. Stroke. 2011. 42: 1546-9.