ICH Score for Intracerebral Haemorrhage
Predicts 30-day mortality in spontaneous intracerebral haemorrhage (ICH) using 5 clinical and radiological variables. Guides prognostication and goals-of-care discussions.
Score interpretation
ICH Score 0: 0% 30-day mortality in original cohort.
→ Aggressive care appropriate. Neurological HDU. Repeat CT at 24h. Blood pressure management (target SBP < 140 mmHg). Neurosurgery consult (haematoma evacuation if cerebellar > 3 cm or deteriorating).
ICH Score 1: ~13% 30-day mortality.
→ HDU care. Goals-of-care discussion with family. BP management. Reverse anticoagulation urgently (PCC/vitamin K for warfarin; specific reversal agents for DOACs). DVT prophylaxis.
ICH Score 2: ~26% 30-day mortality.
→ ICU/HDU. Goals-of-care discussion essential. Neurosurgery review. Anticoagulation reversal. BP control. Consider palliative pathway if appropriate.
ICH Score 3: ~72% 30-day mortality.
→ ICU. Early goals-of-care / end-of-life discussion with family. Comfort measures if elected. If pursuing aggressive care: ICP monitoring, BP management, neurosurgical review.
ICH Score 4: ~97% 30-day mortality.
→ Palliative care strongly indicated in most cases. Goals-of-care discussion mandatory. Comfort-focused management. Organ donation consideration if appropriate.
ICH Score 5–6: Near 100% 30-day mortality.
→ Palliative care. Comfort-focused management. Early organ donation discussion if patient is eligible and family consents.
Interpretation bands for the ICH Score. Apply clinical judgement and local guidance.
References
- Hemphill JC, et al. The ICH Score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891–897.
Related
Curated clinical cross-links plus same-class fallbacks.
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Edoxaban (AF Stroke Prevention / VTE) · Direct Factor Xa Inhibitor (DOAC)
- Clopidogrel (Stroke/TIA Secondary Prevention) · Antiplatelet (P2Y12 Inhibitor)
- Dabigatran (Stroke Prevention — AF) · Direct Oral Anticoagulant — Thrombin Inhibitor
- Rivaroxaban (Stroke Prevention — AF) · Direct Oral Anticoagulant — Factor Xa Inhibitor
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.