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, Atlanta, Georgia. 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⁾.