How to Simplify In-Hospital Aneurysmal Subarachnoid Hemorrhage Outcome: The Hospital Assessment Scale

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) remains a life-threatening condition with high mortality and disability rates, despite advances in treatment. Accurate clinical outcome assessment is essential for patient care and research; yet, a standardized approach is currently lacking. A structured PubMed search was conducted using the keywords “aneurysmal subarachnoid hemorrhage,” “assessment scale,” and “outcome.” Titles, abstracts, and full texts of eligible studies were screened. Extracted data were analyzed to summarize the use, strengths, and limitations of outcome assessment instruments applied in aSAH research. Simplistic dichotomization into “favorable” or “unfavorable” outcomes fails to reflect the full clinical spectrum. More detailed instruments such as the extended Glasgow Outcome Scale and structured modified Rankin Scale interviews exist but are often impractical in routine neurosurgical settings. Recent international efforts, including a 2025 Delphi survey, highlight the need to incorporate cognitive, emotional, and functional domains into outcome evaluation–areas still underrepresented. To address these gaps, we propose the Hospital Assessment Scale (HAS), a simplified four-point ordinal scale for inhospital use. A score of 0 indicates no neurological deficit; 1 indicates a deficit not requiring caregiver support; 2 indicates a deficit requiring support; and 3 indicates death. The HAS provides a standardized, nondichotomized approach, supports discharge planning, and enhances consistency across clinical studies. : Implementing the HAS may enhance the quality and comparability of outcome assessment in aSAH, thereby improving clinical decision-making and the design of future studies.