How it's calculated
GCS band (0-2 points), haemorrhage volume ≥30cm³ (1 point), intraventricular extension (1 point), infratentorial origin (1 point), and age ≥80 (1 point) are summed for a total of 0-6, estimating 30-day mortality.
Score interpretation
| ICH Score | Approximate 30-day mortality |
|---|---|
| 0 | ~0% |
| 1 | ~13% |
| 2 | ~26% |
| 3 | ~72% |
| 4 | ~97% |
| 5-6 | ~100% |
Clinical use
- Used for prognostic discussion with families after intracerebral haemorrhage, alongside imaging and clinical trajectory — not intended to unilaterally guide withdrawal-of-care decisions, since early aggressive care recommendations may themselves influence outcome (a self-fulfilling prophecy effect described in ICH literature).
- Haemorrhage volume is typically estimated using the ABC/2 method on CT imaging.
- Should be interpreted alongside trajectory of neurological status over the first 24-72 hours, not just the initial presentation values.
- The original cohort predates some modern interventions (e.g. minimally invasive haematoma evacuation trials), so absolute mortality figures may not fully reflect contemporary practice at all centres.
Frequently asked questions
What is the ICH Score used for?
It estimates 30-day mortality risk after intracerebral haemorrhage using GCS, haemorrhage volume, intraventricular extension, location, and age — mainly to support prognostic discussion.
How is haemorrhage volume estimated?
Most commonly using the ABC/2 method applied to the CT scan, which approximates the ellipsoid volume of the haematoma.
Should this score be used to decide on withdrawing care?
It should inform, not unilaterally drive, such decisions — early aggressive care recommendations based on a poor initial score can themselves influence outcome, a recognised limitation of ICH prognostic scores.
What does an ICH Score of 0 mean?
It corresponds to close to 0% predicted 30-day mortality in the original cohort, though individual outcomes still depend on clinical trajectory and care received.
References
- Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891-897.
- Hemphill JC 3rd, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: AHA/ASA Guideline. Stroke. 2015;46(7):2032-2060.