Neurocritical care
Intracerebral Hemorrhage (ICH) Score
The ICH score predicts 30-day mortality in spontaneous intracerebral hemorrhage. It incorporates neurologic status, age, hematoma volume, intraventricular extension, and infratentorial location.
Volume can be approximated using the ABC/2 method from CT imaging.
Component points
- GCS0
- Age ≥ 800
- Volume ≥ 30 mL0
- IVH present0
- Infratentorial0
Total ICH score
0
Range 0–6
ICH score 0 corresponds to an estimated 30-day mortality ≈ 0% in the original study, although disability remains common.
Use shared decision-making when discussing prognosis; modern management may improve outcomes beyond original estimates.
How to Use This Calculator
Assess neurologic status
Record the Glasgow Coma Scale on arrival or prior to sedation/intubation.
Quantify hematoma characteristics
Measure hemorrhage volume and identify intraventricular extension or infratentorial location on CT.
Discuss prognosis in context
Combine the ICH score with age, comorbidities, hematoma expansion risk, and patient wishes when counselling families.
Formula
- GCS 3–4: +2 points; GCS 5–12: +1 point; GCS 13–15: +0 points.
- Age ≥ 80 years: +1 point.
- ICH volume ≥ 30 mL: +1 point.
- Intraventricular hemorrhage present: +1 point.
- Infratentorial origin (cerebellum/brainstem): +1 point.
Total score ranges from 0 to 6.
Full Description
The ICH Score (Hemphill et al., 2001) is a simple bedside tool for prognostication in spontaneous intracerebral hemorrhage. It blends neurologic examination (GCS) with hemorrhage burden and anatomy. Higher scores correlate with increased 30-day mortality in validation cohorts. The score aids family discussions, triage, and research stratification.
Limitations: It does not capture hematoma expansion, do-not-resuscitate decisions, or modern interventions such as minimally invasive surgery. Mortality estimates may differ across institutions and populations, so interpret in conjunction with contemporary outcome data and individual patient factors.
Frequently Asked Questions
How do I calculate hemorrhage volume?
Use the ABC/2 method: A = largest diameter, B = diameter perpendicular to A, C = number of slices × slice thickness with hemorrhage; Volume ≈ (A × B × C) / 2.
Does the score apply to secondary ICH (e.g., aneurysm)?
The original score targets spontaneous (primary) ICH. Use caution when applying to secondary causes; prognosis may differ.
Can I use the score for outcome prediction beyond mortality?
The ICH score was validated for 30-day mortality. Functional outcomes (mRS) correlate but require additional assessment tools.
Should a high score limit aggressive treatment?
No. Use the score to inform, not dictate, management. Discuss patient values, comorbidities, and potential for recovery before limiting care.