Intracerebral Hemorrhage (ICH) Score

What is the ICH Score?

The Intracerebral Hemorrhage (ICH) Score is a clinical grading scale developed by Dr. J. Claude Hemphill and colleagues to predict 30-day mortality in patients with intracerebral hemorrhage. It was first published in 2001 and has since been validated in multiple studies as a reliable tool for risk stratification.

This scoring system combines five independent predictors of mortality to create a simple, reliable, and widely applicable prognostic tool that can be used in the acute setting to guide clinical decision-making and discussions with patients and families.

Clinical Significance

The ICH Score helps clinicians:

• Objectively assess the severity of intracerebral hemorrhage
• Predict short-term mortality risk
• Guide treatment decisions and resource allocation
• Facilitate discussions about prognosis with patients and families
• Standardize assessment for research purposes

While the ICH Score is primarily designed to predict 30-day mortality, studies have shown that it also correlates with long-term functional outcomes and quality of life in survivors.

Mortality Risk by ICH Score

Note: These mortality rates are based on the original validation study. Individual patient outcomes may vary based on additional factors and advances in ICH management.

Management Considerations

The ICH Score should be used as one of several tools to guide clinical decision-making, not as the sole determinant of care. Management considerations based on ICH Score may include:

Limitations

While the ICH Score is a valuable tool, it has several limitations:

• It does not account for all factors that may influence outcomes, such as:
  • Timing of presentation
  • Anticoagulation status
  • Blood pressure control
  • Comorbidities
  • Access to specialized neurocritical care
• It was developed before some modern management strategies were implemented
• It predicts mortality but not functional outcomes in survivors
• It may not be as accurate in certain populations or hemorrhage types
• Clinical judgment should always be used alongside the score

Modified versions of the ICH Score, such as the ICH-GS (ICH Grading Scale), have been developed to address some of these limitations and may provide additional prognostic information.

References

1. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891-897.
2. Hemphill JC 3rd, Farrant M, Neill TA Jr. Prospective validation of the ICH Score for 12-month functional outcome. Neurology. 2009;73(14):1088-1094.
3. Clarke JL, Johnston SC, Farrant M, Bernstein R, Tong D, Hemphill JC 3rd. External validation of the ICH score. Neurocrit Care. 2004;1(1):53-60.
4. Ruiz-Sandoval JL, Chiquete E, Romero-Vargas S, Padilla-Martínez JJ, González-Cornejo S. Grading scale for prediction of outcome in primary intracerebral hemorrhages. Stroke. 2007;38(5):1641-1644.