ICH Score Calculator

What Is the ICH Score?

The ICH (Intracerebral Hemorrhage) Score is a validated clinical grading scale used to estimate 30-day mortality risk in patients presenting with spontaneous intracerebral hemorrhage. It combines five independent predictors into a single score ranging from 0 to 6, where higher scores indicate greater mortality risk. The score is widely used in emergency and critical care settings to support clinical decision-making, risk stratification, and communication with patients and families.

How the ICH Score Is Calculated

The score is derived from five clinical components, each assigned points based on specific criteria:

• GCS Score: 2 points for GCS 3–4, 1 point for GCS 5–12, 0 points for GCS 13–15
• Age: 1 point if age ≥ 80 years, 0 points if younger
• Infratentorial Origin: 1 point if the hemorrhage originates in the posterior fossa (brainstem or cerebellum), 0 points if supratentorial
• ICH Volume: 1 point if volume ≥ 30 cm³, 0 points if smaller
• Intraventricular Hemorrhage (IVH): 1 point if present, 0 points if absent

The total score is the sum of all points, with a maximum of 6. Each component is assessed using standard clinical and radiographic criteria at the time of presentation.

Interpreting the ICH Score

The ICH Score correlates with 30-day mortality risk. While individual outcomes vary, the following general risk estimates are reported in the original validation study:

• Score 0: 0% mortality
• Score 1: 13% mortality
• Score 2: 26% mortality
• Score 3: 72% mortality
• Score 4: 97% mortality
• Score 5: 100% mortality
• Score 6: 100% mortality

These percentages represent population-level estimates, not individual predictions. The score is a prognostic tool, not a definitive outcome predictor. Clinical judgment, patient preferences, and evolving clinical status should always be considered alongside the score.

Clinical Use Cases

The ICH Score is used in several clinical contexts:

• Emergency Triage: Helps prioritize patients for intensive monitoring or surgical intervention based on risk severity.
• Prognostic Discussion: Provides a structured framework for discussing expected outcomes with patients and families.
• Research Stratification: Used in clinical studies to categorize patients by baseline risk for subgroup analysis or trial enrollment.
• Quality Benchmarking: Some institutions use the score to compare observed versus expected outcomes as part of quality improvement efforts.

Limitations and Considerations

The ICH Score has several important limitations that clinicians should understand:

• Derived from a single cohort: The original validation was based on patients from one institution, and performance may vary in different populations or care settings.
• Does not account for all variables: Factors such as anticoagulant use, blood pressure management, withdrawal of care decisions, and surgical intervention are not included in the score but can significantly affect outcomes.
• Not a substitute for clinical judgment: The score should support, not replace, individualized assessment by an experienced clinician.
• Limited to 30-day mortality: The score does not predict functional outcomes, long-term disability, or quality of life after survival.
• Volume measurement variability: ICH volume estimation (typically using the ABC/2 method) has inherent measurement variability that can affect scoring.

Common Mistakes When Using the ICH Score

• Applying to traumatic hemorrhage: The ICH Score is validated only for spontaneous (non-traumatic) intracerebral hemorrhage, not for traumatic brain injury.
• Using post-resuscitation GCS: The GCS component should be assessed at presentation before sedation or intubation, as these interventions can alter the score.
• Misclassifying infratentorial origin: Only hemorrhages originating in the brainstem or cerebellum qualify for the infratentorial point. Supratentorial hemorrhages with extension into these areas do not count.
• Overinterpreting individual scores: A score of 3 does not guarantee 72% mortality for a specific patient. The score describes group risk, not individual certainty.