WFNS grade (subarachnoid haemorrhage)
GCS-based clinical grade of subarachnoid haemorrhage
- World Federation of Neurosurgical Societies 1988
Sources last checked: 2026-10-13
WFNS grade (subarachnoid haemorrhage)
GCS-based clinical grade of subarachnoid haemorrhage
The 1988 table does not define GCS 15 with a focal motor deficit; this calculator grades every GCS 15 as I. Grade after resuscitation (e.g. hydrocephalus drained, seizure ended) — an early poor grade may improve.
Interpretation
| Grade I | GCS 15. |
|---|---|
| Grade II | GCS 13–14, no focal motor deficit. |
| Grade III | GCS 13–14 with focal motor deficit. |
| Grade IV | GCS 7–12. Poor grade (IV–V). |
| Grade V | GCS 3–6. Poor grade (IV–V). |
What is the WFNS grade (subarachnoid haemorrhage)?
The WFNS grade classifies subarachnoid haemorrhage into five grades using the Glasgow Coma Scale and the presence of a focal motor deficit. A committee of the World Federation of Neurosurgical Societies chaired by Drake proposed it in 1988 as a universal grading scale. It is the grading system most used in European neurovascular centres and in SAH trials.
When to use it
- Clinical grading of every confirmed subarachnoid haemorrhage at admission.
- Prognostic stratification and trial eligibility.
- Standardised handover between emergency department, neurosurgery and intensive care.
When not to use it
- In sedated or intubated patients without a pre-sedation GCS — the grade depends on an accurate GCS.
- As the sole prognostic tool; age, aneurysm characteristics and imaging grade also matter.
How it is calculated
Grade I: GCS 15 · Grade II: GCS 13–14 without focal motor deficit · Grade III: GCS 13–14 with focal motor deficit · Grade IV: GCS 7–12 · Grade V: GCS 3–6.
Clinical pearls and limitations
- The 1988 table does not define GCS 15 with a focal motor deficit; this calculator grades every GCS 15 as I. Grade after resuscitation (e.g. hydrocephalus drained, seizure ended) — an early poor grade may improve.
- The focal motor deficit only matters at GCS 13–14, where it separates grades II and III.
- The 1988 table does not define GCS 15 with a focal motor deficit; this calculator grades it as I — record the deficit separately.
- Poor grade (IV–V) at presentation can improve after external ventricular drainage; grade again after resuscitation.
- A modified WFNS (Sano 2015) grades II and III by GCS 14 and 13 alone; do not mix versions.
Frequently asked questions
How do I calculate the WFNS grade?
Take the GCS: 15 is grade I, 13–14 is grade II without or grade III with a focal motor deficit, 7–12 is grade IV and 3–6 is grade V.
Which is better, WFNS or Hunt & Hess?
WFNS is more reproducible because it relies on the GCS; both correlate with outcome. Many centres report both.
What is the modified WFNS scale?
A 2015 Japanese modification that drops the motor deficit criterion and assigns GCS 14 to grade II and GCS 13 to grade III.
Evidence and guidelines
- Primary source: Drake CG et al. Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg 1988;68(6):985-986.
- Rosen DS, Macdonald RL. Subarachnoid hemorrhage grading scales: a systematic review. Neurocrit Care 2005;2(2):110-118.
- Sano H et al. Modified World Federation of Neurosurgical Societies subarachnoid hemorrhage grading system. Surg Neurol Int 2016;7(Suppl 18):S502-S503.
- Steiner T et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 2013;35(2):93-112.
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