ICH Score

ICH Score

 

Component ICH Score Points
GCS score
3–4 2
5–12 1
13–15 0
ICH volume, cm3
≥30 1
<30 0
IVH
Yes 1
No 0
Infratentorial origin of ICH
Yes 1
No 0
Age, y
≥80 1
<80 0
Total ICH Score 0–6

GCS score indicates GCS score on initial presentation (or after resuscitation); ICH volume, volume on initial CT calculated using ABC/2 method; and IVH, presence of any IVH on initial CT.

30 Day Mortality

ICH Score Mortality Rate
0 0%
1 13%
2 26%
3 72%
4 94%
5 100%
6* 100%

The ICH Score and 30-day mortality. Thirty-day mortality increases as ICH Score increases. No patient with an ICH Score of 0 died. All patients with an ICH Score of 5 died. No patient in the UCSF ICH cohort had an ICH Score of 6, although this would be expected to be associated with mortality.

Reference

Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH Score. A Simple, Reliable Grading Scale for Intracerebral Hemorrhage. 

Abstract

Background and Purpose—Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes and remains without a treatment of proven benefit. Despite several existing outcome prediction models for ICH, there is no standard clinical grading scale for ICH analogous to those for traumatic brain injury, subarachnoid hemorrhage, or ischemic stroke.

Methods—Records of all patients with acute ICH presenting to the University of California, San Francisco during 1997–1998 were reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the ICH Score) was developed with weighting of independent predictors based on strength of association.

Results—Factors independently associated with 30-day mortality were Glasgow Coma Scale score (P<0.001), age ≥80 years (P=0.001), infratentorial origin of ICH (P=0.03), ICH volume (P=0.047), and presence of intraventricular hemorrhage (P=0.052). The ICH Score was the sum of individual points assigned as follows: GCS score 3 to 4 (=2 points), 5 to 12 (=1), 13 to 15 (=0); age ≥80 years yes (=1), no (=0); infratentorial origin yes (=1), no (=0); ICH volume ≥30 cm3 (=1), <30 cm3 (=0); and intraventricular hemorrhage yes (=1), no (=0). All 26 patients with an ICH Score of 0 survived, and all 6 patients with an ICH Score of 5 died. Thirty-day mortality increased steadily with ICH Score (P<0.005).

Conclusions—The ICH Score is a simple clinical grading scale that allows risk stratification on presentation with ICH. The use of a scale such as the ICH Score could improve standardization of clinical treatment protocols and clinical research studies in ICH.