Fisher Grade

When it activates

Scribeable activates a calculator from the encounter. The Fisher Grade can activate when the transcript or pasted chart context documents any of these:

• SAH CT classification
• Vasospasm risk assessment
• SAH imaging interpretation
• SAH management planning
• Post-SAH monitoring intensity decision

Note-type scope: it activates on notes whose subject resolves to neurology, emergency medicine, critical care. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.

Inputs the note needs

1 input. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.

Scoring

Grade 1: No blood detected on CT. Grade 2: Diffuse or thin layer of subarachnoid blood <1mm thick. Grade 3: Localized clot and/or thick layer >1mm. Grade 4: Diffuse or no subarachnoid blood with intracerebral or intraventricular hemorrhage.

Interpretation

Grade 1: Minimal vasospasm risk. Grade 2: Low vasospasm risk. Grade 3: Highest vasospasm risk (~33% symptomatic vasospasm) — aggressive monitoring and nimodipine. Grade 4: Moderate risk, but ICH/IVH carries independent poor prognosis. All SAH patients: nimodipine 60mg q4h for 21 days, daily TCDs.

Evidence

Sources carried in Scribeable's citation registry for this calculator; guideline version: Fisher CM et al. 1980.

• Fisher CM et al. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning (Fisher Grade)Fisher et al. (Fisher Grade) 1980 · 1980 · link last verified 2026-03-28

How Scribeable handles it in the note

When an encounter activates the Fisher Grade (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.

The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a Fisher Grade value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.

Classified as a staging or classification system: activated strictly, because a wrong stage on the wrong patient is a documentation hazard.

Related calculators

• Hunt-Hess ScaleGrades clinical severity of subarachnoid hemorrhage to predict outcome and guide management
• NIH Stroke Scale (NIHSS)Quantifies stroke severity and monitors neurological changes
• Modified Rankin Scale (mRS)Measures degree of disability and dependence after stroke or neurological event
• FOUR Score (Full Outline of UnResponsiveness)Assesses comatose patients with greater neurological detail than GCS, including brainstem reflexes and respiration
• ABCD2 ScoreEstimates short-term stroke risk after TIA
• Canadian CT Head RuleDetermines need for CT head in patients with minor head injury (GCS 13-15) to identify clinically important brain injury

Can activate in: Emergency Medicine, Neurology, Neurosurgery, Critical Care / ICU, Radiology & Interventional Radiology.