ICH Score Calculator
Calculate ICH score from age, GCS, volume, intraventricular bleed, and infratentorial origin with 30-day mortality estimates.
What Is the ICH Score?
The ICH score predicts 30-day mortality after spontaneous intracerebral hemorrhage (ICH). It uses five bedside and imaging variables: age, Glasgow Coma Scale (GCS), hemorrhage volume, intraventricular extension, and infratentorial origin. Scores range from 0 to 6, with higher scores linked to sharply rising mortality. Estimate hemorrhage volume with the ICH Volume Calculator and assess consciousness with the Glasgow Coma Scale Calculator.
Scoring Components
Age 80 years or older adds 1 point. GCS below 5 adds 2 points; GCS 5 to 12 adds 1 point; GCS 13 to 15 adds 0. ICH volume of 30 mL or more adds 1 point. Intraventricular hemorrhage adds 1 point. Infratentorial (posterior fossa or brainstem) origin adds 1 point. Each component reflects factors associated with hematoma expansion, herniation, and poor functional outcome.
Mortality by Score
Published 30-day mortality estimates are approximately 0% for score 0, 13% for score 1, 26% for score 2, 72% for score 3, 94% for score 4, and near 100% for scores 5 and 6. These figures come from validation cohorts and support prognostic counseling and goals-of-care discussions. They do not replace individualized clinical judgment.
Frequently Asked Questions
What does each ICH score mean for mortality?
Estimated 30-day mortality rises from about 0% at score 0 to roughly 13%, 26%, 72%, and 94% for scores 1 through 4, and near 100% for scores 5 and 6 in classic validation data.
How is GCS scored in the ICH score?
GCS 13 to 15 earns 0 points, GCS 5 to 12 earns 1 point, and GCS below 5 earns 2 points. Use the best motor, verbal, and eye response available at initial assessment.
Why does ICH volume of 30 mL matter?
Hemorrhages of 30 mL or larger add 1 point because larger hematomas correlate with higher mortality and worse functional recovery. Volume is often measured on CT using the ABC2 method.
What is intraventricular hemorrhage in ICH scoring?
Blood extending into the ventricular system adds 1 point. IVH is associated with hydrocephalus, higher ICP, and increased mortality independent of parenchymal volume.
Should the ICH score guide withdrawal of care?
The ICH score informs prognosis but should not alone determine treatment limits. Early scores may change with intervention, and functional outcomes vary. Decisions require multidisciplinary discussion with patients or surrogates.
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