Neuro Scores

Intracerebral Hemorrhage Score (ICH Score) Calculator

Grades spontaneous intracerebral hemorrhage at presentation and gives the 30-day mortality seen at each score.

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

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Formula

GCS 3–4 +2, 5–12 +1, 13–15 0
ICH volume 30 cm³ or more +1
Intraventricular hemorrhage +1
Infratentorial origin +1
Age 80 or older +1
Total 0–6
Volume by ABC/2: A and B are the largest perpendicular diameters on the slice with the most blood and C is the height (slices × slice thickness), all in cm

How it is used

• 30-day mortality by score: 0 = 0%, 1 = 13%, 2 = 26%, 3 = 72%, 4 = 97%, 5 = 100%; no patient scored 6 (Hemphill 2001).
• Built for consistent communication and risk grouping at presentation, from one US center in 1997–1998; it is for spontaneous ICH, not trauma or subarachnoid hemorrhage (Hemphill 2001).
• Guidelines advise full care and postponing new do-not-resuscitate or withdrawal decisions until at least the second full hospital day, because early limits make a poor outcome self-fulfilling (AHA/ASA 2015, carried into the 2022 guideline).

Key points

• Do not use the score alone to withhold or withdraw treatment.

Same formula as the app. Open it in the web app.

Related one-pagers

• Neuro: ICP and StrokeThe ICH score (GCS 3–4 = 2 or 5–12 = 1; volume ≥30 mL; IVH; infratentorial; age ≥80) gave 30-day mortality from 0% at 0 to 72% at 3 (Hemphill 2001). Early limits on care make such scores self-fulfilling (2022 AHA/ASA). Up to a third expand, mostly within 6 h. Priorities: smooth BP control (variability predicts worse outcome), glucose, normothermia, a swallow screen, compression devices from admission (CLOTS 3) and low-dose heparin after 24–48 h. Cerebellar ICH with decline, brainstem compression or hydrocephalus needs evacuation. Minimally invasive evacuation of lobar ICH improved function in ENRICH (2024).
• Subarachnoid Hemorrhage

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For education and exam preparation only. Follow your institution’s protocols. For education and exam preparation only. Verify results independently and follow your institution’s protocols. Not a substitute for clinical judgment.