ICH Score for Intracerebral Hemorrhage Calculator

How does this ICH score for intracerebral hemorrhage calculator work?

This is a health tool that aims to assess brain bleed prognosis and mortality risk in patients with intracerebral hemorrhage based on patient presentation, Glasgow coma scale scoring and CT findings.

The clinical CT evidence such as the volume of hematoma on baseline CT scan, location (infratentorial or supratentorial), and the presence of intraventricular extension, is essential in predicting the outcome. 

There are five factors taken in consideration in the ICH score for intracerebral hemorrhage calculator, as follows:

■ Glasgow Coma Score – taking into consideration level of consciousness, eye opening, verbal response and motor response. A GCS between 13 and 15 weighs the least (0 points) in the ICH score, while severe GCS scores such as 3 or 4 weigh the most (2 points).

■ Age – is considered one of the risk factors in increasing 30 day mortality in case of intracranial bleed with the baseline of 80 and above.

■ ICH volume of 30 ml or higher – brain hemorrhage survival rate is also strongly connected to the blood amount lost.

■ Intraventricular hemorrhage present – computer tomography finding, increasing the risk for complications due to the cerebral hematoma.

■ Infratentorial origin of hemorrhage – bleeding origin, relevant as a factor risk in the ICH model.

Another factor to be accounted for by the clinician is any therapy the patient might currently be undergoing, especially anticoagulation or anti-platelet therapy.

The emergency department and then neurosurgery are the first routes for patient with suspect intracranial hemorrhage, in some case, then transfer to the intensive care unit is required. Permanent monitoring is essential to prevent other complications, neurological decompensation or airways sequelae.

Spontaneous intracerebral hemorrhage (SICH) is another condition for which the ICH score has proven its reliability in predicting the 30 day mortality and 1 year functional outcome.

Beside the ICH score, there are other models such as the HAS-BLED score or the CRUSADE score for bleeding risk who look into the changes of a hemorrhage due to anticoagulation therapy or similar conditions.

ICH score interpretation

Each of the answers in the 5 factors above weighs differently in the final score based on the ICH guidelines, with the Glasgow outcome score assessment being the most relevant. The result is then correlated with the 30 day mortality risk as resulted from the original study. The following table presents the percentages:

Having in consideration that the ICH guidelines aim at administering the test upon admission, recent studies suggest that given the changes in ICH patients and in intracerebral hematoma dimensions can be rapid during hospitalization, the score should be administered at 24h after admission as well to help in monitoring prognosis. This measure is yet to be implemented.

References

1) Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. (2001) The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke; 32(4):891-7.

2) Ruiz-Sandoval JL, Chiquete E, Romero-Vargas S, Padilla-Martínez JJ, González-Cornejo S. (2007) Grading scale for prediction of outcome in primary intracerebral hemorrhages. Stroke; 38(5):1641-4.

3) Zis P, Leivadeas P, Michas D, Kravaritis D, Angelidakis P, Tavernarakis A. (2014) Predicting 30-day case fatality of primary inoperable intracerebral hemorrhage based on findings at the emergency department. J Stroke Cerebrovasc Dis; 23(7):1928-33.

4) Appelboom G, Hwang BY, Bruce SS, Piazza MA, Kellner CP, Meyers PM, Connolly ES. (2012) Predicting outcome after arteriovenous malformation-associated intracerebral hemorrhage with the original ICH score. World Neurosurg; 78(6):646-50.