van Donkelaar CE, et al. - In this investigation, researchers developed and validated a precise bedside prediction model for clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH) in order to support early decision-making. A prospectively maintained single-center cohort of 1215 aSAH patients admitted between 1998 and 2014 was used to develop the prediction model. A prospective cohort of 224 consecutive aSAH patients from the same center admitted from 2015 to 2017 was used for temporal validation. Using the ISAT (International Subarachnoid Aneurysm Trial) database (2143 patients), external validation was performed. The final model included 4 independently associated predictors after 2 months of poor outcome: age, World Federation of Neurosurgical Societies grade after resuscitation, aneurysm size, and Fisher grade. In both validation cohorts, the model exhibited satisfactory calibration. The grading scale of SAFIRE was derived from the final model: size of the aneurysm, age, Fisher grade, world federation of neurosurgical societies after resuscitation. According to this observational cohort study, the SAFIRE grading scale is a model for early prediction of clinical outcome after aSAH that is accurate, generalizable and easily applicable.