ICH Score Calculator

Calculate Intracerebral Hemorrhage Score to assess 30-day mortality risk in patients with brain hemorrhage.

The ICH Score is a validated clinical prediction rule that helps healthcare professionals assess the 30-day mortality risk in patients with intracerebral hemorrhage based on five key clinical variables.

Examples

Click on any example to load it into the calculator.

Mild ICH Case

Mild ICH Case

Young patient with small hemorrhage and good neurological status.

Age: 45 years

GCS Score: 14

ICH Volume: 15 cm³

IVH: No

Infratentorial: No

Moderate ICH Case

Moderate ICH Case

Middle-aged patient with moderate hemorrhage and some neurological impairment.

Age: 65 years

GCS Score: 10

ICH Volume: 35 cm³

IVH: Yes

Infratentorial: No

Severe ICH Case

Severe ICH Case

Elderly patient with large hemorrhage and severe neurological impairment.

Age: 78 years

GCS Score: 6

ICH Volume: 60 cm³

IVH: Yes

Infratentorial: Yes

Infratentorial ICH

Infratentorial ICH

Patient with brainstem hemorrhage requiring special consideration.

Age: 55 years

GCS Score: 8

ICH Volume: 20 cm³

IVH: No

Infratentorial: Yes

Other Titles
Understanding ICH Score Calculator: A Comprehensive Guide
Master the clinical assessment of intracerebral hemorrhage patients using the validated ICH Score. Learn how to calculate, interpret, and apply this critical tool in emergency neurology and stroke care.

What is the ICH Score Calculator?

  • Clinical Prediction Rule
  • Neurological Assessment Tool
  • Mortality Risk Stratification
The ICH Score Calculator is a validated clinical prediction rule developed to assess 30-day mortality risk in patients with intracerebral hemorrhage (ICH). This critical tool helps healthcare professionals make informed decisions about patient management, family counseling, and resource allocation in emergency neurology settings. The calculator transforms five key clinical variables into a numerical score that correlates with mortality risk, providing objective data to support clinical judgment and improve patient outcomes.
The Clinical Significance of ICH Scoring
Intracerebral hemorrhage represents a medical emergency with significant morbidity and mortality. The ICH Score was developed through rigorous clinical research and validation studies, making it one of the most reliable tools for predicting outcomes in this patient population. Unlike subjective assessments, the ICH Score provides standardized, reproducible risk stratification that helps clinicians communicate prognosis to families, guide treatment decisions, and identify patients who may benefit from aggressive interventions or palliative care approaches.
Components of the ICH Score System
The ICH Score incorporates five clinically relevant variables that have been shown to independently predict mortality: patient age, Glasgow Coma Scale (GCS) score, ICH volume, presence of intraventricular hemorrhage (IVH), and infratentorial origin. Each variable contributes 0-2 points to the total score, with higher scores indicating worse prognosis. The scoring system was designed to be simple enough for bedside use while maintaining strong predictive accuracy for 30-day mortality outcomes.
Validation and Clinical Evidence
The ICH Score has been extensively validated in multiple patient populations and healthcare settings worldwide. Studies have consistently demonstrated its reliability in predicting 30-day mortality, with area-under-the-curve (AUC) values typically ranging from 0.72 to 0.85. This level of predictive accuracy makes the ICH Score a valuable tool for clinical decision-making, research protocols, and quality improvement initiatives in stroke care.

Key Clinical Applications:

  • Emergency Department Triage: Rapid assessment of patient severity and resource needs
  • Family Counseling: Objective communication of prognosis and expected outcomes
  • Treatment Planning: Guidance for aggressive vs. conservative management approaches
  • Research Protocols: Standardized patient stratification for clinical trials

Step-by-Step Guide to Using the ICH Calculator

  • Data Collection and Assessment
  • Score Calculation Methodology
  • Result Interpretation and Application
Accurate ICH Score calculation requires systematic data collection, proper clinical assessment, and careful interpretation of results. Follow this comprehensive methodology to ensure reliable risk stratification and optimal patient care.
1. Patient Age Assessment
Record the patient's chronological age in years. Age is a critical predictor in the ICH Score, with patients aged 80 years and older receiving 2 points, those aged 65-79 receiving 1 point, and patients under 65 receiving 0 points. This reflects the well-established relationship between advancing age and increased mortality risk in intracerebral hemorrhage, likely due to decreased physiological reserve and increased comorbidity burden.
2. Glasgow Coma Scale Evaluation
Perform a standardized GCS assessment, evaluating eye opening, verbal response, and motor response. GCS scores of 3-4 receive 2 points, scores of 5-12 receive 1 point, and scores of 13-15 receive 0 points. The GCS provides crucial information about neurological function and consciousness level, serving as a surrogate marker for the severity of brain injury and intracranial pressure effects.
3. ICH Volume Measurement
Calculate ICH volume using the ABC/2 method on CT imaging: multiply the longest diameter (A) by the perpendicular diameter (B) by the number of slices containing hemorrhage (C), then divide by 2. Volumes ≥30 cm³ receive 1 point, while volumes <30 cm³ receive 0 points. ICH volume directly correlates with mass effect, intracranial pressure, and neurological compromise severity.
4. Intraventricular Hemorrhage Assessment
Evaluate CT imaging for the presence of blood in the ventricular system. The presence of IVH receives 1 point, while absence receives 0 points. IVH indicates more severe hemorrhage and is associated with increased intracranial pressure, hydrocephalus risk, and worse neurological outcomes due to direct ventricular system involvement.
5. Infratentorial Origin Determination
Identify whether the hemorrhage originates from infratentorial structures (brainstem or cerebellum). Infratentorial origin receives 1 point, while supratentorial origin receives 0 points. Infratentorial hemorrhages have unique management considerations due to their proximity to critical brainstem structures and different surgical approaches.

Score Calculation Examples:

  • Score 0: Young patient (45), GCS 15, small hemorrhage (15 cm³), no IVH, supratentorial
  • Score 2: Elderly patient (75), GCS 12, moderate hemorrhage (35 cm³), no IVH, supratentorial
  • Score 4: Elderly patient (82), GCS 6, large hemorrhage (50 cm³), IVH present, supratentorial
  • Score 6: Elderly patient (85), GCS 3, massive hemorrhage (80 cm³), IVH present, infratentorial

Real-World Applications and Clinical Decision Making

  • Emergency Department Management
  • Neurosurgical Consultation
  • Family Communication and Prognosis
The ICH Score transforms from a simple calculation into a powerful clinical decision-making tool when applied thoughtfully across various healthcare settings and patient care scenarios.
Emergency Department Triage and Management
In emergency departments, the ICH Score helps clinicians rapidly assess patient severity and determine appropriate care pathways. Patients with low scores (0-1) may be candidates for standard stroke unit care, while those with high scores (4-6) may require intensive care unit admission and aggressive monitoring. The score also guides decisions about neurosurgical consultation, with higher scores often prompting earlier surgical evaluation for potential intervention.
Neurosurgical Decision Making
Neurosurgeons use the ICH Score to evaluate surgical candidacy and timing. While the score itself doesn't determine surgical intervention, it provides important prognostic information that factors into risk-benefit analysis. Patients with very high scores may have limited surgical benefit, while those with moderate scores may benefit from careful consideration of surgical options. The score also helps guide family discussions about surgical risks and expected outcomes.
Family Communication and Prognostic Counseling
Perhaps most importantly, the ICH Score provides objective data for family discussions about prognosis and expected outcomes. Families often seek clear information about their loved one's chances of survival and recovery. The score's validated mortality predictions help clinicians provide honest, evidence-based information while acknowledging individual patient variability. This supports informed decision-making about treatment goals, code status, and end-of-life care preferences.

Clinical Decision Framework:

  • Score 0-1: Standard stroke unit care, good prognosis, aggressive rehabilitation
  • Score 2-3: Intensive monitoring, consider neurosurgical consultation, guarded prognosis
  • Score 4-5: ICU care, limited surgical benefit, focus on comfort and family support
  • Score 6: Palliative care consideration, very poor prognosis, family counseling priority

Common Misconceptions and Best Practices

  • Score Limitations and Context
  • Individual Patient Factors
  • Dynamic Assessment Requirements
Effective use of the ICH Score requires understanding its limitations and implementing best practices that balance objective scoring with individual patient circumstances and clinical judgment.
Myth: The ICH Score is Deterministic
A common misconception is that the ICH Score provides absolute predictions that override clinical judgment. Reality: The score provides probability estimates based on population data, but individual patients may have outcomes that differ from predicted risks. Factors such as pre-morbid functional status, comorbidities, time to presentation, and treatment response can significantly influence outcomes. The score should inform but not replace comprehensive clinical assessment and family discussions.
Limitations and Context Considerations
The ICH Score has several important limitations. It was developed and validated primarily in academic medical centers, potentially limiting generalizability to community hospitals. The score doesn't account for important factors such as hemorrhage location within lobes, presence of underlying vascular malformations, or specific comorbidities. Additionally, the score provides 30-day mortality prediction but doesn't address functional outcomes, quality of life, or long-term prognosis.
Dynamic Assessment and Score Evolution
The ICH Score should be viewed as a dynamic tool that may change as the patient's condition evolves. Initial scores may be influenced by factors such as time from onset, sedation, or metabolic derangements. Serial assessments may show score improvement with treatment or deterioration with complications. Clinicians should reassess scores periodically and adjust management strategies accordingly, recognizing that the score reflects a snapshot in time rather than a fixed prediction.

Best Practice Principles:

  • Use as Clinical Guide: Combine score with comprehensive patient assessment
  • Serial Evaluation: Reassess score as patient condition evolves
  • Family Communication: Use score to support honest, compassionate discussions
  • Individual Context: Consider patient-specific factors beyond score variables

Mathematical Derivation and Statistical Validation

  • Score Development Methodology
  • Validation Studies and Evidence
  • Statistical Performance Metrics
Understanding the mathematical foundation and statistical validation of the ICH Score enhances its appropriate clinical application and interpretation.
Original Development and Validation
The ICH Score was developed using data from 152 patients with spontaneous ICH treated at Massachusetts General Hospital between 1994 and 1999. Researchers identified five independent predictors of 30-day mortality through multivariate logistic regression analysis. Each variable was assigned points based on its odds ratio for mortality, creating a simple additive scoring system. The original validation showed excellent discrimination with an area-under-the-curve (AUC) of 0.82 for 30-day mortality prediction.
Statistical Performance and Validation Studies
Multiple validation studies across different populations have confirmed the ICH Score's reliability. Meta-analyses have shown consistent AUC values ranging from 0.72 to 0.85, indicating good to excellent discrimination. The score demonstrates good calibration, meaning predicted mortality rates closely match observed rates across different score levels. However, some studies suggest the score may overestimate mortality in certain populations, particularly those with access to modern critical care.
Score Categories and Mortality Rates
The ICH Score stratifies patients into risk categories with corresponding 30-day mortality rates: Score 0 (0% mortality), Score 1 (13% mortality), Score 2 (26% mortality), Score 3 (72% mortality), Score 4 (97% mortality), and Score 5-6 (100% mortality). These rates provide clinicians with specific probability estimates for family counseling and clinical decision-making. However, it's important to note that these are population-based estimates and individual outcomes may vary significantly.

Statistical Performance Metrics:

  • Discrimination (AUC): 0.72-0.85 across validation studies
  • Calibration: Good fit between predicted and observed mortality rates
  • Sensitivity: High for identifying patients with poor prognosis
  • Specificity: Moderate for identifying patients with good prognosis