ICH Score

ICH Score

The ICH Score: What It Is and What It Is Not 1).

Simple and reliable clinical grading score that is used for predicting the early mortality of patients with intracerebral hemorrhage (ICH).

The ICH Score has become the standard for risk-stratification of 30-d mortality in patients with intracerebral hemorrhage (ICH), but treatment has evolved over the last 17 yr since its inception.

The ICH score is a useful tool for predicting 30-day mortality both in patient who use and patients who do not use OAC. Although OAC use is an independent predictor of 30-day mortality, addition of OAC use to the existing ICH score does not increase the prognostic performance of this score 2)

The ICH Score is 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 cm(3) (=1), <30 cm(3) (=0);

Intraventricular hemorrhage yes (=1), no (=0).

Patient 68 years old GCS 4: ICH 4 score

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) 3).

Malinova et al. evaluated the reproducibility of the ICH-score in ICH patients undergoing fibrinolytic therapy.

They performed a retrospective analysis of patients with supratentorial ICH managed by fibrinolytic therapy and evaluated the 30-day mortality. The ICH-score was then applied to match the mortality in the patients with the mortality predicted by the ICH-score. The ICH-score is based on parameters available at admission: age, hematoma volume, intraventricular expansion, and clinical status according to the Glasgow Coma Scale.

A total of 233 patients were analyzed. The 30-day mortality rate was 30% (70/233). An age of ≥80 years was associated with a significantly higher mortality rate (OR 2.26, chi-square test p = 0.01). A hematoma volume of ≥30 mL led significantly more often to 30-day mortality (OR 3.72, chi-square test p = 0.01). The mortality was significantly higher in patients with intraventricular hemorrhage (2.97, chi-square test p = 0.003). The ICH-score showed a significant correlation with mortality (chi-square test, p < 0.0001). The following mortality rates were estimated using the ICH-score in our cohort: 1 = 0% (0/13), 2 = 0% (0/51), 3 = 1.3% (1/82), 4 = 43% (13/31), 5 = 100% (56/56). : The ICH-score not only allowed a reliable estimation of the 30-day mortality in patients with ICH treated conservatively but also treated by clot lysis. Compared to conservative treatment, fibrinolytic therapy reduced the 30-day mortality in patients with ICH-scores 1-4. Patients with ICH-score 5 do not have a benefit of fibrinolytic therapy and should no longer be considered to be candidates for fibrinolytic therapy 4).

The original ICH score did not accurately predict the mortality rate in the series of the Department of Neurosurgery, Emory University, AtlantaGeorgia. Patient survival exceeded ICH Score-predicted mortality regardless of surgical intervention. Reevaluation of predictive scores could be useful to aid in more accurate prognoses 5).



Hemphill JC 3rd. The ICH Score: What It Is and What It Is Not. World Neurosurg. 2018 Dec 20. pii: S1878-8750(18)32883-3. doi: 10.1016/j.wneu.2018.12.060. [Epub ahead of print] PubMed PMID: 30580061.

Houben R, Schreuder FHBM, Bekelaar KJ, Claessens D, van Oostenbrugge RJ, Staals J. Predicting Prognosis of Intracerebral Hemorrhage (ICH): Performance of ICH Score Is Not Improved by Adding Oral Anticoagulant Use. Front Neurol. 2018 Feb 28;9:100. doi: 10.3389/fneur.2018.00100. eCollection 2018. PubMed PMID: 29541054; PubMed Central PMCID: PMC5836590.

Hemphill JC III, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;14:891–897. doi: 10.1161/01.STR.32.4.891.

Malinova V, Iliev B, Mielke D, Rohde V. Intracerebral Hemorrhage-Score Allows a Reliable Prediction of Mortality in Patients with Spontaneous Intracerebral Hemorrhage Managed by Fibrinolytic Therapy. Cerebrovasc Dis. 2019 Nov 13:1-6. doi: 10.1159/000504246. [Epub ahead of print] PubMed PMID: 31722333.

McCracken DJ, Lovasik BP, McCracken CE, Frerich JM, McDougal ME, Ratcliff JJ, Barrow DL, Pradilla G. The Intracerebral Hemorrhage Score: A Self-Fulfilling Prophecy? Neurosurgery. 2018 May 14. doi:

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