To determine characteristics of patients and outcomes of patients admitted from the emergency department with traumatic subarachnoid hemorrhage, providing a more comprehensive risk stratification of patients with subarachnoid hemorrhage. We performed an IRB-approved retrospective study of patients admitted to a rural academic tertiary referral trauma center in a large health system between 1/1/2007 and 8/31/2017. We collected demographic data, initial evaluation and clinical outcomes data, and performed descriptive statistical analyses. A consecutive sample of 211 cases of acute traumatic subarachnoid hemorrhage (tSAH) were reviewed. Over half were female (61%), mean age was 73 years, and most patients were White (99%). The most common mechanism of injury was fall from standing (52%) followed by motor vehicle accident (18%) and fall down steps (12%). Approximately 38% of patients displayed confusion or altered mental status and 35% of patients complained of headache after their trauma. Nearly half (48%) had a history of loss of consciousness or were amnestic to the event. Nearly half of patients were taking aspirin (45%) and some were on other antiplatelet medications (11%), and approximately 15% of patients were on systemic anticoagulation. During their hospitalization, neurosurgery was consulted on 98% of the patients. Inpatient mortality of patients requiring intubation either out-of-hospital or in the emergency department was 22%. Of the 211 cases, 94 patients did not have concurrent neurologic comorbidities, including presence of cerebral contusions, cerebral edema, intracerebral hemorrhage, intraventricular hemorrhage, subdural hemorrhage, epidural hemorrhage, skull fracture, spinal fractures or spinal cord compression. Patients with comorbid neurologic injuries tended to be on aspirin (50% vs. 40%), another antiplatelet medication (12% vs. 11%) or systemic anticoagulation (16% vs. 13%) compared to patients without co-morbid neurologic injuries. Patients without co-morbid neurologic injuries had a shorter ICU (0.7 vs. 2.7 days) and hospital length-of-stay (7.2 vs. 3.7 days) and had a lower in-hospital mortality (14% vs. 2%). A majority of patients with tSAH had either loss of consciousness, headache, or altered mental status following the injury, and these clnical findings might be suggestive of SAH. Patients with tSAH and concurrent co-morbid neurologic injuries required a longer hospital stay and tended to be on aspirin, other anti-platelet medications, or systemic anticoagulation. Individuals who required intubation in the emergency department or out-of-hospital had a higher inpatient mortality. More investigation is needed to outline patient characteristics and management involved to determine ways to better risk stratify these patients.