ICH Note Template: Score, BP, Reversal, Plan
An ICH note builder for residents: enter GCS, volume, location, IVH and the anticoagulant; the ICH score, reversal line and plan write themselves.
Reviewed by Zaka Ahmed, MD Clinical reference · 4 min read
ICH Note Builder
⚠ Do not enter names, dates of birth, MRNs, or any other identifier. Nothing is stored on our servers.Educational documentation aid for clinicians. It applies published guideline logic to what you enter; it does not know your patient. Verify every line, follow your institutional protocol, and use clinical judgment. Full disclaimer. All builders in one place: the residents’ workspace.
Assistant (beta)
Type or dictate your one-line impression and the assistant fills the fields above; the plan itself still comes from the rule set, not from the model. No identifiers — the text goes to our own server and on to a language-model provider, and is not stored.
My phrases — the builder learns your service
Add the lines your attending always wants. Saved in this browser only and appended to the section you choose every time you build this note.
Clinical notes & interpretation Scoring guidance, pitfalls, FAQs, and references
The ICH note has to say four things in the first hour: the score, the blood-pressure target, the reversal agent, and whether neurosurgery is needed tonight.
- → The ICH score is computed from what you enter (GCS, volume, IVH, infratentorial location, age) and written with the caution that early care limitation biases the mortality estimates.
- → Reversal is agent-specific and the builder writes the right one: 4-factor PCC plus vitamin K for warfarin, andexanet or PCC for factor Xa inhibitors, idarucizumab for dabigatran, and no platelet transfusion for antiplatelet-associated bleeds (PATCH).
- → Cerebellar hemorrhage with mass effect or hydrocephalus is flagged in red as a surgical emergency; lobar 30–80 mL bleeds get the ENRICH minimally invasive evacuation line.
What changes the plan
Location and volume drive the surgical section; the anticoagulant at presentation drives the reversal section; GCS, IVH, and hydrocephalus drive the EVD and ICU lines; and the indication for anticoagulation (atrial fibrillation, mechanical valve, recent VTE) together with the bleed phenotype (deep hypertensive versus lobar/amyloid) drives the resumption line. That last one is where progress notes usually go silent, and it is the question the family and the primary team will ask on day three.
Blood pressure the way the trials did it
The builder writes a smooth target of SBP 130–150 mmHg reached within an hour and held, and it adds a caution when the arrival pressure is very high, because aggressive drops from above 220 were not shown to help and may harm the kidney and the penumbra. It also writes the long-term target — under 130/80 — because controlled blood pressure is the most effective recurrence-prevention measure after ICH.
Prognosis without self-fulfilling prophecy
Every ICH note built here carries a line reminding the team not to place new do-not-resuscitate or comfort-only orders in the first 24–48 hours on the basis of the ICH score alone. The score was derived in cohorts where early withdrawal was common, which is why the guideline asks for full support and reassessment first.
Frequently asked questions
How is the ICH score calculated on this page?
From five inputs: GCS (3 to 4 scores 2, 5 to 12 scores 1), hematoma volume 30 mL or more (1), intraventricular extension (1), infratentorial origin (1), and age 80 or older (1). The builder writes the total and the original cohort's 30-day mortality band, with a caution about interpretation.
Why does the plan say not to transfuse platelets for an aspirin-associated bleed?
The PATCH trial found platelet transfusion for antiplatelet-associated ICH was associated with worse outcomes, so guidelines advise against it unless a neurosurgical procedure is planned. The builder writes that line and offers desmopressin as an option to consider.
When can anticoagulation restart after ICH?
The builder writes a phenotype-based answer: for a deep hypertensive bleed with controlled blood pressure, reconsider a DOAC at roughly four to eight weeks after repeat imaging; for lobar or amyloid-related bleeds, resumption is generally avoided or deferred and left atrial appendage occlusion is raised for AF; mechanical valves need earlier multidisciplinary decisions.
References
- Greenberg SM, et al. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage. Stroke. 2022;53:e282–e361.
- Anderson CS, et al. INTERACT2. N Engl J Med. 2013;368:2355–2365. · Qureshi AI, et al. ATACH-2. N Engl J Med. 2016;375:1033–1043.
- Baharoglu MI, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH). Lancet. 2016;387:2605–2613.
- Pradilla G, et al. Trial of early minimally invasive removal of intracerebral hemorrhage (ENRICH). N Engl J Med. 2024;390:1277–1289.
- Hemphill JC, et al. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32:891–897.
Related reading
From the articles.
- Types of stroke explained Where intracerebral hemorrhage sits among stroke subtypes.
- 2026 stroke guideline: what changed Updated blood-pressure guidance in context.