ICH Score
30-day mortality prediction in spontaneous intracerebral hemorrhage.
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Why use it
Simple, rapid bedside tool validated in multiple cohorts. Guides prognosis discussions and helps stratify patients for intensive care vs. palliative approaches.
About
The ICH Score is a validated clinical grading scale for predicting 30-day mortality in patients with spontaneous intracerebral hemorrhage. It uses 5 clinical and radiographic variables.
When to use
- Adults with spontaneous (non-traumatic) intracerebral hemorrhage on CT
- Goal-of-care discussions and prognostication
- Triaging ICU vs. step-down level of care
Formula
GCS 3-4: +2 | GCS 5-12: +1 | GCS 13-15: 0
ICH volume ≥30 cm³: +1
IVH present: +1
Infratentorial origin: +1
Age ≥80: +1
Total: 0-6
Pearls & pitfalls
- Score was derived to predict 30-day mortality, not functional outcome.
- Do Not Resuscitate orders placed early may be a confounding factor (self-fulfilling prophecy).
- GCS score is the most impactful variable.
- Infratentorial location (cerebellum/brainstem) adds 1 point.
Next steps
Score 0: 0% 30-day mortality. Score 1: 13%. Score 2: 26%. Score 3: 72%. Score 4: 97%. Score 5: 100%. Use alongside clinical judgment and family discussions.
Evidence
Hemphill et al. Stroke 2001. Validated in 152 patients; AUC 0.97 for 30-day mortality. Multiple external validation studies confirmed predictive accuracy.