An intracerebral hemorrhage (ICH) is a severe form of stroke caused by bleeding directly into the brain tissue. This bleeding interrupts normal brain functions, leading to swelling and increased pressure inside the skull. Since patient outcomes vary widely and change rapidly, medical professionals require a standardized, fast method to assess a patient’s condition upon arrival. This assessment gauges the initial severity of the injury and predicts the potential for recovery, helping medical teams quickly determine the appropriate level of care.
The Primary Prognostic Tool: The ICH Score
The most widely recognized and frequently validated system is the Intracerebral Hemorrhage (ICH) Score. Developed in 2001, this simple clinical scale provides a rapid, reliable assessment for initial risk stratification. The score is calculated by summing points assigned to five distinct variables, all easily obtainable shortly after the patient arrives.
Ranging from zero to six points, the score’s simplicity allows it to be determined quickly by any medical professional. Its primary function is to predict the patient’s likelihood of death within 30 days of the hemorrhage.
The score facilitates consistent communication among healthcare providers regarding a patient’s severity and prognosis. This metric is valuable for clinical research, ensuring study groups are comparable in terms of baseline injury severity. Higher scores consistently correlate with mortality, suggesting a worse prognosis.
Clinical Factors Determining the Score
The ICH Score is derived from five specific clinical and radiological factors, each contributing points based on its association with a worse outcome. The patient’s level of consciousness, measured using the Glasgow Coma Scale (GCS) score, is the most heavily weighted factor. A GCS score of 13–15 receives zero points, 5–12 receives one point, and the lowest scores of 3 or 4 are assigned two points.
The second component is age: patients 80 years old or older are assigned one point, while those under 80 receive zero points. The size of the hemorrhage, known as the ICH Volume, is also a significant factor. If the volume is 30 cubic centimeters or greater, one point is added; volumes less than 30 cubic centimeters receive zero points.
Two other neuroimaging findings complete the score calculation, each contributing one point if present. The presence of Intraventricular Hemorrhage (IVH), which is bleeding extended into the fluid-filled spaces of the brain, is assigned one point. The final factor is the location of the hemorrhage; an infratentorial origin (in the cerebellum or brainstem) is assigned one point, while supratentorial locations receive zero points.
Interpreting Prognosis and Guiding Treatment
The final calculated ICH Score (0 to 6) translates directly into a predicted 30-day mortality rate, guiding the medical team in their clinical decisions. The mortality rates associated with each score are:
- Score 0: 0% mortality rate.
- Score 1: Approximately 13% mortality rate.
- Score 2: Approximately 26% mortality rate.
- Score 3: Approximately 72% mortality rate.
- Score 4: Approximately 97% mortality rate.
- Scores 5 and 6: Estimated 100% mortality rate.
These stark predictions help inform early discussions with the patient’s family about the likely outcomes.
The score influences major treatment decisions, such as whether to pursue aggressive surgical intervention or shift toward palliative care focused on comfort. Patients with low scores (0 or 1) are candidates for all available medical and surgical treatments. Conversely, those with very high scores (4 or 5) may be considered for comfort measures only.
The ICH Score is a prediction tool, not a guarantee, and should not be the sole determinant of treatment decisions. The patient’s wishes and overall condition must also be considered.