Your Hunt & Hess grade reflects the clinical severity of subarachnoid hemorrhage (SAH) at presentation. Grade I indicates a nearly asymptomatic patient or one with only a mild headache and slight nuchal rigidity, carrying approximately 1% surgical mortality. Grade II denotes a moderate-to-severe headache with nuchal rigidity but no neurological deficit beyond a cranial nerve palsy, with roughly 5% surgical mortality. Grade III represents drowsiness, confusion, or mild focal deficit (~19% mortality). Grade IV indicates stupor with moderate-to-severe hemiparesis and early decerebrate posturing (~42% mortality). Grade V signifies deep coma with decerebrate rigidity and a moribund appearance (~77% mortality).

The grade at presentation is one of the strongest predictors of overall outcome after aneurysmal SAH. However, clinical grade can fluctuate — patients may improve or deteriorate due to rebleeding, hydrocephalus, or vasospasm — so serial reassessment is essential.

Use the Hunt & Hess scale immediately upon evaluation of a patient with confirmed or suspected subarachnoid hemorrhage. It is most commonly applied in the emergency department or neurosurgical consultation to communicate clinical severity, guide the urgency of aneurysm intervention (surgical clipping or endovascular coiling), and establish a baseline for prognosis discussions with the patient's family.

Grades I–III are generally considered candidates for early intervention (within 24–72 hours), while Grades IV–V may require stabilization before definitive treatment. The scale is also used in research to stratify SAH patients in clinical trials and outcome studies.

The Hunt & Hess scale is subjective and depends on the examiner's interpretation of clinical status, which can lead to inter-observer variability, particularly between Grades II and III. It does not account for specific neurological deficits, the amount of blood on imaging, or the presence of complications such as hydrocephalus or intraventricular hemorrhage that may independently worsen prognosis.

The scale was developed in 1968 and does not incorporate modern prognostic factors such as patient age, aneurysm location, or the availability of endovascular techniques. It should be used alongside the Fisher CT grade (which assesses vasospasm risk based on blood distribution) and the World Federation of Neurosurgical Societies (WFNS) scale for a more comprehensive assessment. Additionally, a patient's grade can be confounded by sedation, intubation, or metabolic derangements.