ICH Score
Calculate the original ICH Score from GCS, age, hematoma volume, intraventricular extension, and infratentorial origin, with safety-focused interpretation.
Reviewed by Zaka Ahmed, MD Clinical reference · 6 min read
ICH Score
Document all five baseline components. No item is preselected, which helps distinguish a completed zero-point response from missing data.
Safety note. The 2022 AHA/ASA ICH guideline states that baseline severity scales should not be used as the sole basis for forecasting an individual prognosis or limiting life-sustaining treatment.
Clinical notes & interpretation Scoring guidance, pitfalls, FAQs, and references
The ICH Score combines five baseline features into a 0–6 severity summary for spontaneous intracerebral hemorrhage.
- → GCS contributes 0–2 points; age, volume, intraventricular extension, and infratentorial origin contribute one each.
- → The score describes group-level severity. It must not be the sole basis for an individual prognosis, a DNR order, or treatment limitation.
The original ICH Score was designed as a simple, reproducible way to summarize presentation severity across cohorts. The arithmetic is straightforward; the interpretation requires restraint. This version intentionally reports the validated component total without converting it into a deterministic mortality message.
The five components
GCS 13–15 adds 0 points, 5–12 adds 1, and 3–4 adds 2. Hematoma volume at least 30 mL, intraventricular extension, infratentorial origin, and age 80 years or older each add one point. Volume is commonly estimated with the ABC/2 method, but irregular hemorrhages may require planimetry or automated measurement.
Why this calculator omits a mortality percentage
The original cohort showed increasing 30-day mortality with higher scores, but applying those percentages as an individual forecast can create self-fulfilling treatment limitations. Contemporary outcomes depend on factors the score does not capture, including withdrawal-of-care practices, anticoagulant reversal, hematoma expansion, hydrocephalus, surgical candidacy, and the patient’s premorbid state and preferences.
References.
- Hemphill JC III, Bonovich DC, Besmertis L, et al. The ICH Score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32:891–897. PubMed
- Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage. Stroke. 2022;53:e282–e361. AHA/ASA guideline