The hunthess classification system was originally intended to help determine the risk of surgical mortality in patients admitted with asah. Warning headache, projectile vomiting, the hunt and hess scale, fisher scale, world federation of neurological surgeons wfns grading scale, and modified wfns mwfns scale, body mass. The scale was intended to be a gage of surgical risk and to aid neurosurgeons in deciding on the appropriate time after sah at which. Test results and the grade of aneurysm can affect treatment options.
Objective arterial hypertension htn is a risk factor for subarachnoid haemorrhage sah. Acute cytotoxic and vasogenic edema after subarachnoid. Radiologic grading scales include the fisher scale, modified fisher scale, and head ct grading scale table 293. Although the scale is of questionable reliability, a. The hunt and hess and hunt and kosnik scales the hunt and hess scale was proposed in 1968 as a modification to an older system originally reported by botterell and colleagues in 1956 table 1. It was first described in 1968 by two neurosurgeons from ohio, usa. Hunt and hess classification of subarachnoid hemorrhage evidencio. Since the initial hunt and hess scale time is outside of the range listed in the allowable values for hour, it is not a valid time and the abstractor should select utd. The reason is the difficulty in grading subjective clinical symptoms and signs such as headache and level of. Feb 07, 2017 the hunt and hess scale is a clinical grading system used to determine the severity of a subarachnoid hemorrhage.
Risk factors for cerebral vasospasm in patients with spontaneous. This article contains everything you need to know about the hunt and hess scale, and thats wonderful. Aneurysmal subarachnoid hemorrhage in patients with hunt. Therefore, in 1988 the wfns committee on grading proposed a system based on the glasgow coma scale gcs, a scale originally developed for trauma and proven to be very reliable as to interobserver agreement. Altman selfrating mania scale asrm 5 question scale to screen and stage severity of hypomaniamania young mania rating scale ymrs 11 question scale to grade the severity of mania patient health questionnaire4 phq4 ultrabrief screening for anxiety and depression edinburgh postnatal depression scale epds 10 question screener for. In 1968, hunt and hess published a modified version of the fivegrade botterell classification 1,3. Subarachnoid hemorrhage sah is a common and frequently devastating condition, accounting for. Controversy still surrounds the question of when and how to manage cases of subarachnoid hemorrhage of hunt and hess grade iv and v aneurysms. Design retrospective analysis of a prospective cohort study of all sah patients admitted to columbia university medical center between 1996 and 2012. Critical care of poorgrade subarachnoid hemorrhage dgni. Initial hunt and hess scale date cstk03, initial hunt and hess scale performed cstk03, initial hunt and hess scale time cstk03. Because of the perceived limitations of the hunt hess scale, the wfns scale was created. House call pioneers of neuroscience in central ohio by george w. As shown by the results, less severity was observed in condition for pa tients with pmsah, with gradei or ii for the majority of patients.
Subarachnoid hemorrhage an overview sciencedirect topics. Which clinical variable influences healthrelated quality. This scale helps the surgeon assess a patients condition. The presence of a venous delay phenomenon p hunt hess hh, the world federation of neurosurgical societies scale wfns, the modified fisher scale mfs, the subarachnoid hemorrhage early brain edema score sebes, the vasograde, the hair, and the sah score, were proposed to guide the clinical treatment after sah. The presence of a venous delay phenomenon p pdf quick scale measure take off to excel press this button to buy our pdf take off program to measure and export your dims to excel, simply click to markuptakeoff dims and send to excel. Jan 10, 2002 therefore, in 1988 the wfns committee on grading proposed a system based on the glasgow coma scale gcs, a scale originally developed for trauma and proven to be very reliable as to interobserver agreement. Guidelines for the management of aneurysmal subarachnoid. Although neurosurgical referral is widely accepted for hunt and hess grade i and ii and even grade iii cases, it remains controversial for grade iv and v cases 18. Hunt and hess scale for subarachnoid hemorrhage calculator. Which clinical variable influences healthrelated quality of.
There are 5 categories in the scale developed by hunt and hess, two neurosurgeons from the us in. Positive brain image cstk05, positive brain image date cstk05, positive brain image time cstk05, posttreatment thrombolysis in cerebral infarction tici reperfusion grade. The hunt and hess scale describes the severity of subarachnoid hemorrhage resulting from the rupture of an intracerebral aneurysm and is used as a predictor of survival. Figure 1 diffusion weighted imaging and fluid attenuation inversion recovery imaging of a. Other scales which describe the clinical presentation of subarachnoid hemorrhage patients include the. The sah score was found to be more accurate in predicting asah mortality compared with the hunt and hess grade and wfns scale. Most patients had been admitted in the second week or later after bleeding, when the clinical state has usually stabilized. Causes and mechanisms of inhospital death after sah in the modern era of neurocritical care remain incompletely understood. The area under the curve auc for the sah score was. A new subarachnoid hemorrhage grading system based on the glasgow coma scale.
Subarachnoid hemorrhage sah is a devastating form of stroke. We studied 1200 consecutive sah patients prospectively enrolled in the columbia university sah outcomes project between july 1996 and january 2009. Prognosis is inversely proportional to the score, similarly to the hunt and hess scale. Measuresetprintpackage manual performance measurement.
Surgical risk as related to time of intervention in the repair of intracranial aneurysms. Documentation indicates the initial hunt and hess scale time was 3300. The venous delay phenomenon in computed tomography. Hunt and hess grading system radiology reference article. The hunt and hess scale is a clinical grading system used to determine the severity of a subarachnoid hemorrhage. Yes, it is possible to scale the image to pdf page size, by specifying the image height and width in the draw image method. Endovascular treatment of hunt and hess grade iv and v. Surgical risk as related to time of intervention in the repair of intracranial. Several authors are in favor of surgical treatment, reporting improved clinical outcomes and lower mortality rates. This was based on a retrospective study of only 275 patients over a 12year period. Despite improved treatment regimens, high grade subarachnoid hemorrhage is still associated with a poor prognosis. Prediction of symtomatic vasospasm after subarachnoid haemorrhage.
When calculating kendall taub and tauc, the glasgow coma score revealed the strongest correlations to the physically dominated subscales and summary scores. Mar 17, 2007 the wfns scale is more popular than the hunt and hess scale because the latter measures variables that are not of prognostic significance and has interobserver variability. It is used as a predictor of patients prognosisoutcome, with a higher grade correlating to lower survival rate. Functional independence measurement fim glasgow outcome scale gos health survey sf36 health survey sf12 community integration questionnaire. Figure 1 the distribution of patients according to age and. Early aggressive surgical treatment of sah can produce goodquality survival for a higher percentage of patients than previously reported. Although the scale is of questionable reliability, a higher grade usually portends.
The hunt and hess scale was proposed in 1968 as a mod ification to an older. Higher grades, which are reflective of progressively higher hemorrhage severity and neurological dysfunction, are associated with higher overall mortality. Apr 18, 2019 the hunt and hess scale is widely used for categorizing severity of sah. Asymptomatic, mild headache, slight nuchal rigidity. A retrospective study of a series of 78 sah patients treated endovascularly ev or surgically sc and paired according to age, hunthess scale at admission, fischer grade, aneurysm localization and followup time. The wfns scale is more popular than the hunt and hess scale because the latter measures variables that are not of prognostic significance and has interobserver variability. Stratified hunthess comparisons among pmsah, npmsah and asah groups the severity of condition was judged based on the hunthess scale. Hunt and hess scale an overview sciencedirect topics. The hunt and hess scale is the most widely used clinical scale, but its validity and reliability are suboptimal. Initial hunt and hess scale date 148 specifications manual for joint commission national quality measures v2016b1 discharges 010117 1q17 through 063017 2q17 1. William edward hunt 19211999, neurologist and neurosurgeon. The fisher scale is the initial and best known system of classifying the amount of subarachnoid hemorrhage on ct scans, and is useful in predicting the occurrence and severity of cerebral vasospasm, highest in grade 3 2 numerous other scales have been proposed, incorporating various parameters, and aimed at predicting mortality, morbidity andor vasospasm.
More importantly, this information is already contained in the subarachnoid hemorrhage article, so its redundant to have it here. Documentation of the first hunt and hess scale that was done at this hospital. Or documented within 6 hours of arrival at the hospital. This is a health tool that evaluates the severity of subarachnoid hemorrhage based on the presentation symptoms of the patient. Patients in poor clinical condition hunt and hess grade 4 or 5 after subarachnoid hemorrhage sah have historically fared poorly and many often were excluded from aggressive treatment. Scoring is largely based on the severity of neurological impairments as rated by the gcs 22,23,62,63 table 217. Positive brain image 231 positive brain image date 233 positive brain image time 235 post discharge appointment scheduled within 7 days 237 post discharge evaluation conducted within 72. Hunt and hess grade scale hunt and hess grade scale. The authors analyzed cases of hunt and hess grade v sah from 19801995 referred to in this study as the earlier period and 20052014 current period and compared the results for the 2 periods. Grading and decisionmaking in aneurysmal subarachnoid. No other documentation in the medical record provides a valid time. Your surgeon may refer to the hunthess scale see below in discussing treatment options with you.
Hunthess grades of brain aneurysms grade condition of patient i alert, aware of surroundings, showing no symptoms. There are 5 categories in the scale developed by hunt and hess, two neurosurgeons from the us in 1968. Outcome after hunt and hess grade v subarachnoid hemorrhage. The hunt and hess scale is a grading system used to classify the severity of a subarachnoid hemorrhage based on the patients clinical condition. The comparison of the brussels coma score, hunt and hess scale, and world federation of neurosurgical societies scale was the first to reveal the greatest correlations figures 3 and 4. A quick way to get measured data in to an electronic excel takeoff for estimates, valuations, variations, final accounts or the like, its delivered by an. Review article subarachnoid hemorrhage grading scales. Recently, however, several authors have reported improved mortality and morbidity rates, especially among.
To evaluate the clinical and angiographic results as well as the costs of surgical treatment against endovascular treatment in a sah in a paired series of patients. Pdf background and purpose our aim was to describe variables associated with initial misdiagnosis of subarachnoid hemorrhage sah. Cranial nerve palsy or moderate to severe headachenuchal rigidity. Sah hunthess, wfns, fisher scale neurochirurgicka a. How does this hunt and hess scale for subarachnoid hemorrhage calculator work.
We aimed to assess the impact of premorbid htn on the severity of initial bleeding and the risk of aneurysm rebleeding after sah. However, it doesnt amount to very much informationarguably, not enough information to constitute an article. Poorgrade sah patients hunt and hess grade 4 and 5. The hunt and hess scale was developed in 1968 as a clinical grading system to predict prognosis and outcome in patients with subarachnoid hemorrhage sah. Impact of premorbid hypertension on haemorrhage severity. Extent of subarachnoid hemorrhage and development of. Stroke specific quality of life measure ssqol outcome assessment scales. Moderate to severe headache, nuchal rigidity, no neurologic. Pdf misdiagnosis worsens prognosis in subarachnoid. The scale has five grades that range from normal consciousness to major impairments and coma. Considering that endovascular procedures are currently being increasingly used to treat aneurysms, we.
The outcomes of 257 cases were analyzed and stratified on the basis of modified rankin scale mrs scores obtained 6 months after sah. The hunt and hess scale describes the severity of subarachnoid hemorrhage resulting from the rupture of an. Hunt and hess scale the hunt and hess scale, introduced in 1968, is one of the grading systems used to classify the severity of a subarachnoid hemorrhage based on the patients clinical condition. Analysis was performed to identify predictors of inhospital.