Calculate the Intracerebral Hemorrhage (ICH) score and review the historical 30-day and 12-month mortality context alongside the score breakdown.
The Intracerebral Hemorrhage (ICH) Score is a simple prognosis scale for spontaneous intracerebral hemorrhage. It combines five variables that are usually available early in care: Glasgow Coma Scale category, hemorrhage volume, intraventricular extension, infratentorial location, and age 80 or older.
The score is useful because it gives clinicians and families a common language for discussing risk. It is not useful as a stand-alone treatment rule. Bleed expansion, hydrocephalus, posterior fossa compression, anticoagulation status, premorbid function, and the direction of the neurologic exam often matter just as much as the score itself.
This page therefore keeps the score in its proper role: a prognosis worksheet. It shows the component breakdown and the historical mortality context from the original cohorts, while staying away from pretending that one number can decide ICU, surgery, or goals-of-care decisions by itself.
The ICH score gives a fast, standardized way to summarize hemorrhage severity. Used carefully, it can improve communication and prognostic framing without turning one score into a treatment decision.
ICH Score = GCS points (3–4: 2, 5–12: 1, 13–15: 0) + volume points (≥30 cm³: 1) + IVH (yes: 1) + infratentorial origin (yes: 1) + age ≥80 (yes: 1). Observed 30-day mortality in the original derivation cohort: 0 points = 0%, 1 = 13%, 2 = 26%, 3 = 72%, 4 = 97%, 5–6 = 100%.
Result: ICH Score: 0 — historical 30-day mortality context 0%
All five components score 0, giving an ICH score of 0. In the original cohort this was associated with 0% observed 30-day mortality, but the score should still be interpreted alongside imaging changes, hydrocephalus, anticoagulation status, and the clinical course.
One of the most important cautions in hemorrhage prognostication is self-fulfilling prophecy. If a severe score is treated as proof that recovery is impossible, early limitation of care can make the predicted outcome come true. That is why modern interpretation of the ICH score emphasizes its role as a prognosis aid, not a stand-alone decision rule.
Newer tools can incorporate more imaging detail, anticoagulation exposure, or functional outcomes, but the original ICH score remains widely used because it is quick and reproducible. It provides a shared starting point for discussing severity even before more nuanced data are available.
Important factors such as hematoma expansion, hydrocephalus, pre-existing disability, anticoagulation reversal, and response to early neurocritical care are not built into the original score. Those missing pieces are exactly why the score should be read as one layer of context rather than the whole answer.
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This page assigns the original Hemphill ICH Score points for GCS band, hemorrhage volume threshold, intraventricular extension, infratentorial origin, and age 80 or older, then maps the total to the original 30-day mortality context and a later 12-month outcome reference. It is intended to keep the component logic visible so the score can be reviewed as prognosis context rather than as a black-box output.
The result is not a treatment rule or a stand-alone goals-of-care decision. Expansion risk, hydrocephalus, posterior fossa compression, anticoagulation reversal, premorbid function, and the neurologic trajectory still matter beyond the initial score.
It is mainly used as a short prognosis worksheet after spontaneous intracerebral hemorrhage. It summarizes severity and helps frame discussions, but it does not replace imaging review, neurologic reassessment, or bedside judgment.
The common quick estimate is the ABC/2 method on CT: A is the largest diameter, B is the largest perpendicular diameter, and C reflects the number of slices with hemorrhage multiplied by slice thickness. It is an approximation, but it is practical and widely used.
No. Prognostic scores can contribute to self-fulfilling prophecy if they are treated like a stand-alone answer. The score should support discussion, not determine whether a patient receives full initial stabilization and ongoing reassessment.
Blood in the ventricles is associated with worse outcomes because it can contribute to hydrocephalus, inflammation, and additional injury beyond the primary parenchymal bleed.
Posterior fossa hemorrhages can become dangerous at smaller volumes because of the limited space around the brainstem and cerebellum. That is why location influences the score even without any other added variable.
Anticoagulation can increase the risk of hematoma expansion and complicate prognosis, but it is not part of the original ICH score. Reversal strategy depends on the agent involved and the treating team’s emergency pathway rather than on the score alone.