Hunt-Hess Scale
Grades clinical severity of subarachnoid hemorrhage to predict outcome and guide management
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a detected disagreeing draft value is flagged for correction
- Scoring type
- classification
- Care settings
- Emergency department, ICU, Inpatient
When it activates
Scribeable activates a calculator from the encounter. The Hunt-Hess Scale can activate when the transcript or pasted chart context documents any of these:
- Subarachnoid hemorrhage grading
- SAH severity assessment
- Aneurysmal SAH management
- SAH surgical/interventional decision
- SAH prognostication
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: I60.
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; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Hunt-Hess grade (1-5) | exam |
Scoring
Grade 1: Asymptomatic or minimal headache, slight nuchal rigidity. Grade 2: Moderate to severe headache, nuchal rigidity, no neurological deficit except cranial nerve palsy. Grade 3: Drowsiness, confusion, or mild focal deficit. Grade 4: Stupor, moderate to severe hemiparesis, possible early decerebrate rigidity. Grade 5: Deep coma, decerebrate rigidity, moribund appearance.
Hunt-Hess grade Hunt-Hess grade (1-5) (1=asymptomatic/minimal HA, 2=moderate-severe HA/nuchal rigidity, 3=drowsy/mild deficit, 4=stuporous/hemiparesis, 5=deep coma/decerebrate)
Interpretation
Grade 1-2: Good prognosis (~70% good outcome), early surgical/endovascular intervention recommended. Grade 3: Intermediate prognosis (~50%), typically still proceed with intervention. Grade 4-5: Poor prognosis (<20% good outcome), management decisions more complex, may need stabilization before intervention.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Hunt WE & Hess RM 1968.
- Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysmsHunt & Hess 1968 · 1968 · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Hunt-Hess Scale at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a Hunt-Hess Scale 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.
See it activate on your own encounter
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