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The ICH Score is the most widely used clinical grading scale for predicting 30-day mortality after spontaneous intracerebral hemorrhage (ICH). Developed by Dr. J. Claude Hemphill III and colleagues at the University of California, San Francisco in 2001, the ICH Score provides a simple, reliable, and rapid prognostic assessment using five clinical and radiographic variables that are routinely available at the time of initial evaluation.
Intracerebral hemorrhage is the deadliest form of stroke, accounting for 10–20% of all strokes but carrying a 30-day mortality rate of approximately 40%. Early and accurate prognostication is essential for guiding treatment decisions, communicating with families, and determining the appropriate level of care. The ICH Score addresses this need by combining five independent predictors of mortality into a single composite score.
The five components are: Glasgow Coma Scale (GCS) category (scored 0–2), ICH volume (≥30 mL = 1 point), presence of intraventricular hemorrhage (IVH) (1 point), infratentorial origin of hemorrhage (1 point), and age ≥80 years (1 point). The total score ranges from 0 to 6, with higher scores predicting higher mortality. In the original validation, 30-day mortality ranged from 0% for a score of 0 to 100% for a score of 5–6.
This calculator computes the ICH Score and provides corresponding 30-day mortality estimates, supporting evidence-based prognostication and clinical communication in the acute management of intracerebral hemorrhage.
The ICH Score sums five components:
Total range: 0–6. 30-day mortality by score: 0 = 0%, 1 = 13%, 2 = 26%, 3 = 72%, 4 = 97%, 5 = 100%, 6 = 100%.
An ICH Score of 0 predicts 0% 30-day mortality — these patients generally have small supratentorial hemorrhages with preserved consciousness. A score of 1 carries 13% mortality. A score of 2 carries 26% mortality. A score of 3 carries 72% mortality, representing a sharp increase in death risk. Scores of 4–6 predict near-certain mortality (97–100%). Importantly, the ICH Score should inform but not determine care withdrawal decisions, as some patients with high scores do survive with aggressive management.
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ICH Score 0 — alert patient, small supratentorial bleed, no IVH, age <80. Excellent prognosis.
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ICH Score 5 — comatose (GCS 3–4), large bleed with IVH, elderly. 100% predicted 30-day mortality.
The ICH Score is a validated 6-point grading scale that predicts 30-day mortality after spontaneous intracerebral hemorrhage using five variables: GCS, hemorrhage volume, intraventricular hemorrhage, infratentorial origin, and age.
The score sums points from five components: GCS category (0–2), ICH volume ≥30 mL (0–1), IVH presence (0–1), infratentorial origin (0–1), and age ≥80 (0–1), for a total range of 0–6.
An ICH Score of 3 carries approximately 72% 30-day mortality, representing a critical threshold where prognosis shifts from potentially survivable to predominantly fatal.
No. Guidelines specifically warn against using the ICH Score alone to make decisions about withdrawal of care. Self-fulfilling prophecy is a concern — patients not treated aggressively due to high scores will not have the opportunity to recover.
Infratentorial (posterior fossa) hemorrhages are more dangerous than supratentorial ones because they can compress the brainstem and fourth ventricle, causing rapid deterioration. Even small infratentorial hemorrhages can be fatal.
ICH volume is most commonly estimated using the ABC/2 method from CT scan measurements, or calculated using computer-assisted volumetric analysis for more precision.
Yes. The presence of IVH significantly worsens prognosis because it can cause obstructive hydrocephalus, increased intracranial pressure, and chemical irritation of the ventricular system.
The maximum score is 6 (GCS 3–4 = 2 points, volume ≥30 mL, IVH present, infratentorial, age ≥80). However, the original study reported that no patients with a score of 6 were observed, likely because this combination is very rare.
Yes. The ICH Score has been extensively validated in multiple international cohorts and is recommended by AHA/ASA guidelines for prognostic assessment in intracerebral hemorrhage.
The ICH Score was primarily designed to predict mortality. While higher scores correlate with worse functional outcomes among survivors, other tools may better predict the specific level of disability.
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