ICH Score

The ICH Score (Hemphill et al., Stroke 2001) is the most widely validated clinical grading scale for early prognostication after spontaneous intracerebral hemorrhage. Five simple variables, each available within the first hours of presentation, are summed: Glasgow Coma Scale (3–4 scores 2 points, 5–12 scores 1 point, 13–15 scores 0), ICH volume on the presentation CT (30 cm³ or more scores 1 point; use the ABC/2 calculator to estimate volume), intraventricular hemorrhage (present scores 1 point), infratentorial origin — brainstem or cerebellar hemorrhage — (present scores 1 point), and age (80 years or older scores 1 point). In the original 26-patient derivation and 161-patient validation cohorts, 30-day mortality rose steeply with score: 0% at a score of 0, 13% at 1, 26% at 2, 72% at 3, 97% at 4, and 100% at 5; no patients in the original cohort had a score of 6, which is assumed close to uniformly fatal. The score is a prognostic aid for early discussion and triage, not a directive to withdraw care, and should not by itself drive treatment-limitation decisions given the risk of self-fulfilling prophecy described in follow-up literature.