ICH score
30-day mortality risk in spontaneous intracerebral haemorrhage
Sources last checked: 2026-10-13
ICH score
30-day mortality risk in spontaneous intracerebral haemorrhage
Derived in 152 patients at a single centre (UCSF, 1997–98) in an era of frequent early care limitation. A high score on its own is not a basis for withholding or withdrawing treatment — doing so risks a self-fulfilling prophecy.
Interpretation
| 0 | 30-day mortality 0 % in the derivation cohort (all 26 patients survived). |
|---|---|
| 1 | 30-day mortality ≈ 13 % in the derivation cohort. |
| 2 | 30-day mortality ≈ 26 %. |
| 3 | 30-day mortality ≈ 72 %. |
| 4 | 30-day mortality ≈ 97 %. |
| 5–6 | All 6 patients with score 5 died; no patient scored 6 in the derivation cohort. |
What is the ICH score?
The ICH score grades spontaneous intracerebral haemorrhage from 0 to 6 using GCS, haematoma volume, intraventricular extension, infratentorial origin and age. Hemphill and colleagues derived it in 2001 from 152 patients treated at the University of California, San Francisco, with 30-day mortality as the outcome. It is used to standardise communication and research, not to make individual prognostic decisions.
When to use it
- Standardised severity description at admission of spontaneous ICH.
- Stratification in registries, audits and clinical studies.
- Structuring early discussions about severity with the team.
When not to use it
- To justify early do-not-resuscitate orders or withdrawal of care — guidelines warn against basing this on a score.
- Traumatic, tumour-related or haemorrhagic transformation of an infarct; it was derived in primary ICH.
- As a functional outcome predictor; it was built for 30-day mortality.
How it is calculated
| Criterion | Points |
|---|---|
| Glasgow Coma Scale | |
| 13–15 | 0 |
| 5–12 | 1 |
| 3–4 | 2 |
| ICH volume ≥ 30 mL | +1 |
| Intraventricular haemorrhage | +1 |
| Infratentorial origin | +1 |
| Age ≥ 80 years | +1 |
Clinical pearls and limitations
- Derived in 152 patients at a single centre (UCSF, 1997–98) in an era of frequent early care limitation. A high score on its own is not a basis for withholding or withdrawing treatment — doing so risks a self-fulfilling prophecy.
- Measure the haematoma with ABC/2 on the first CT: largest diameter (A), perpendicular diameter (B) and number of slices × slice thickness (C), in cm; divide by 2.
- GCS is taken on presentation or after initial resuscitation, not after sedation.
- The derivation cohort was small and included early care limitation; observed mortality in modern cohorts with full treatment is often lower.
- A score of 6 is possible but did not occur in the derivation cohort.
Frequently asked questions
How is ICH volume calculated?
With the ABC/2 method: multiply the three perpendicular diameters in centimetres and divide by 2 to get millilitres.
What is the mortality for an ICH score of 3?
About 72 % at 30 days in the 2001 derivation cohort. Contemporary cohorts with aggressive care may differ.
Does the ICH score predict functional outcome?
It correlates with outcome, but it was designed for 30-day mortality. Functional prognosis is better judged after the first days of full treatment.
Evidence and guidelines
Have a follow-up question?
Medelix answers clinical questions from current guidelines and studies — every statement with its source.
Ask Medelix about the ICH scoreRelated calculators
Embed this calculatorFree to use on your website, intranet or teaching page. Copy the code below.
<iframe src="https://medelix.ai/en/embed/ich-score" title="ICH score – Medelix" width="100%" height="620" style="border:0;max-width:720px" loading="lazy"></iframe>
<p><a href="https://medelix.ai/en/calculators/ich-score">ICH score calculator by Medelix</a></p>For healthcare professionals and medical students. These tools support, and do not replace, clinical judgement. Always check results against the original source and your local protocols.