ICH Score Calculator

The standard ICH grading scale aggregates individual risk points assigned to distinct clinical variables measured upon initial presentation. The composite score ranges from 0 to 6, where each incremental point correlates with a progressively higher risk of 30-day mortality. The core equation sums individual weighted risk components:

ICH Score = GCS Points + Age Points + Volume Points + Intraventricular Hemorrhage Points + Infratentorial Origin Points

Specifically, a Glasgow Coma Scale score of 3 to 4 awards 2 points, 5 to 12 awards 1 point, and 13 to 15 awards 0 points. Age 80 years or older grants 1 point (under 80 grants 0). A hematoma volume of 30 cm³ or greater yields 1 point. The presence of intraventricular hemorrhage (IVH) adds 1 point, and an infratentorial (brainstem or cerebellar) origin adds 1 point.

Consider a 74-year-old patient who arrives at the emergency department following an acute stroke. Upon examination, the patient has a Glasgow Coma Scale score of 10 (awarding 1 point). Neuroimaging reveals a deep basal ganglia hematoma with an estimated volume of 35 cm³ (awarding 1 point for volume ≥ 30 cm³). The scan also confirms blood extension into the ventricles (awarding 1 point for intraventricular hemorrhage). The origin of the bleed is supratentorial, adding 0 points. Because the patient is 74, they receive 0 points for age.

Summing these values: 1 (GCS) + 0 (Age) + 1 (Volume) + 1 (IVH) + 0 (Origin) = an ICH Score of 3. An ICH score of 3 correlates with a significantly elevated historical 30-day mortality rate, guiding critical care discussions and family counseling regarding aggressive therapeutic interventions.

Always evaluate the Glasgow Coma Scale prior to the administration of any paralytic or sedative medications that could artificially depress neurological status. Accurately measuring hematoma volume using standard ABC/2 methodology on head CT scans is crucial, as underestimating volume can misclassify a patient's risk tier. Remember that the ICH score provides statistical probabilities for populations rather than absolute individual outcomes; it should always be used alongside comprehensive clinical judgment and multidisciplinary team evaluations.