Hunt and Hess Classification for SAH
Classifies subarachnoid haemorrhage severity based on clinical presentation. Predicts surgical risk and outcome.
Score interpretation
Hunt & Hess I–II: 30-day mortality ~10–25%
→ Early surgical clipping or endovascular coiling; nimodipine 60 mg Q4h; neurocritical care
Hunt & Hess III: 30-day mortality ~30–40%
→ Neurosurgery/neuroradiology referral; coiling preferred; nimodipine; monitor for vasospasm and hydrocephalus
Hunt & Hess IV–V: 30-day mortality >60–80%
→ Goals of care discussion; ICU; EVD if hydrocephalus; treatment decision individualised; neuropalliative approach if Grade V
Interpretation bands for the Hunt & Hess. Apply clinical judgement and local guidance.
References
- 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.
Related
Curated clinical cross-links plus same-class fallbacks.
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Featured in these MRCEM clinical pathways
The Hunt & Hess is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.