Intracerebral Haemorrhage Score

The ICH score grades ICH severity and subsequent 30 day mortality, and so may help guide goals of care planning with patients’ families.

While the score can be a marker for ICH severity, it is not the only factor used to guide treatment options.

History

The ICH score was developed at the University of California, San Francisco Medical Center (UCSF), with the original study analysing 161 patients presenting with ICH to UCSF between 1997-1998

• Original study: The ICH score: a simple, reliable grading scale for intracerebral hemorrhage (2001)
• Validation: External validation of the ICH score. (2004)
• Online Calculator at MDCalc

---

Scoring method

Parameter	Result	Score
Glasgow Coma Score (GCS)	13–15	0
	5–12	1
	3–4	2
Age ≥ 80	No	0
	Yes	1
ICH volume ≥ 30 mL	No	0
	Yes	1
Intraventricular haemorrhage	No	0
	Yes	1
Origin of haemorrhage	Supratentorial	0
	Infratentorial	1

Interpretation:

ICH Score	30-day mortality
0	0%
1	13%
2	26%
3	72%
4	94%
5	100%
6	100%

Management

Clinical decisions regarding interventions and goals of care are not made solely on the ICH score.

Other important factors such as patients’ and families’ wishes, baseline neurologic status, the nature of the bleed, the location of the bleed, and other co-morbidities are also taken into consideration.

---

References

Publications

• Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001 Apr;32(4):891-7. 
• 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.
• Baharoglu MI et al; PATCH Investigators. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet. 2016 Jun 25;387(10038):2605-2613.
• Clinical Guidelines for Acute Stroke Management – National Stroke Foundation
• Brazis PW, Masdeu JC, Biller J. Localization in Clinical Neurology. 8e 2021
• Fuller G. Neurological Examination Made Easy. 6e 2019
• O’Brien M. Aids to the Examination of the Peripheral Nervous System. 6e 2023

FOAMed

• Gibbs M. Neuroimaging Cases 004. LITFL
• Flower O. EVACUATE: ICH Management. LITFL
• Suresh Kochath P. CT Case 078. LITFL
• Lam L. CT Case 022. LITFL
• Coni R. Neuro 101: Cerebral Hemispheres. LITFL