Hunt and Hess scale

Hunt and Hess scale is a grading system used to classify the severity of a subarachnoid hemorrhage (SAH) based on the patient's clinical condition. The scale was introduced in 1968 by William Hunt and Robert Hess as a way to assess the prognosis of patients with SAH and to help guide treatment decisions. The Hunt and Hess scale ranges from Grade I, indicating a mild condition, to Grade V, which signifies a severe condition with a poor prognosis.

Grades

The Hunt and Hess scale includes the following grades:

• Grade I: Asymptomatic or minimal headache and slight nuchal rigidity. No neurological deficit other than cranial nerve palsy.
• Grade II: Moderate to severe headache, nuchal rigidity, no neurological deficit other than cranial nerve palsy.
• Grade III: Drowsiness, confusion, or mild focal deficit.
• Grade IV: Stupor, moderate to severe hemiparesis, possibly early decerebrate rigidity, and vegetative disturbances.
• Grade V: Deep coma, decerebrate rigidity, moribund appearance.

Clinical Application

The Hunt and Hess scale is primarily used by healthcare professionals to quickly assess the severity of a subarachnoid hemorrhage and to make initial decisions about the best course of treatment. It is an important tool in the management of SAH patients, as it helps to predict outcomes and guide interventions. The scale is also used in research settings to stratify patients and to compare outcomes across different treatment modalities.

Limitations

While the Hunt and Hess scale is widely used, it has some limitations. The scale is somewhat subjective, as it relies on clinical judgment to assess the severity of symptoms. This can lead to variability in grading between different observers. Additionally, the scale does not take into account factors such as age, the presence of other medical conditions, or the size and location of the hemorrhage, which can also affect prognosis.

See Also

• Subarachnoid hemorrhage
• Glasgow Coma Scale
• World Federation of Neurological Surgeons grading system