ICH Score Calculator
Calculate the ICH Score for 30-day mortality risk prediction after intracerebral hemorrhage using GCS, age, infratentorial origin, ICH volume, and IVH status with detailed breakdown.
About This Calculator
The ICH Score Calculator (Intracerebral Hemorrhage) is a clinical decision-support tool designed for healthcare professionals — neurologists, neurosurgeons, intensivists, emergency physicians, and medical students — to calculate the validated ICH Score for 30-day mortality risk stratification after spontaneous intracerebral hemorrhage.
The ICH Score was first described by Hemphill et al. in 2001 (Stroke) and is calculated from five clinical and radiographic criteria: Glasgow Coma Scale (GCS) score categorized into three tiers (13-15: 0 points, 5-12: 1 point, 3-4: 2 points), age ≥ 80 years (1 point), infratentorial origin of hemorrhage (1 point), ICH volume ≥ 30 mL measured via CT using the ABC/2 method (1 point), and presence of intraventricular hemorrhage (IVH) (1 point). The total score ranges from 0 to 6, with higher scores associated with progressively higher 30-day mortality rates.
The 30-day mortality rates corresponding to each score are: 0 = 0%, 1 = 13%, 2 = 26%, 3 = 72%, 4 = 97%, 5 = 100%, and 6 = 100%. The score is widely used in clinical practice to facilitate prognostic discussions, guide level-of-care decisions, and stratify patients for clinical trials. Regional variations in outcomes have been noted, and the score performs well across diverse healthcare settings in India, the United States, and the United Kingdom.
Regional Notes: In India, ICH accounts for a higher proportion of strokes (20-30%) compared to Western populations, often due to untreated hypertension. The ICH Score has been validated in Indian cohorts and remains a reliable prognostic tool. In the US, the AHA/ASA guidelines recommend the ICH Score for early prognostication. In the UK, the Royal College of Physicians stroke guidelines reference the ICH Score as part of comprehensive stroke care assessment. This calculator is for reference and educational purposes only — always consult a qualified healthcare professional for medical decision-making.
Frequently Asked Questions
What is the ICH Score?
The ICH Score is a validated clinical grading scale developed by Hemphill et al. (2001) that predicts 30-day mortality after spontaneous intracerebral hemorrhage. It assigns points based on five criteria: Glasgow Coma Scale (GCS), age, infratentorial origin, ICH volume, and presence of intraventricular hemorrhage (IVH), for a total score ranging from 0 to 6.
How is the ICH Score calculated?
The ICH Score is calculated by summing points from five components: GCS 13-15 = 0 pts, 5-12 = 1 pt, 3-4 = 2 pts; age less than 80 = 0 pts, 80 or older = 1 pt; infratentorial origin: no = 0 pts, yes = 1 pt; ICH volume less than 30 mL = 0 pts, 30 mL or more = 1 pt; IVH absent = 0 pts, present = 1 pt. Total scores range from 0 (best prognosis) to 6 (worst prognosis).
What do ICH Score results mean?
The ICH Score predicts 30-day mortality: Score 0 = 0% mortality (very low risk), Score 1 = 13% (low risk), Score 2 = 26% (moderate risk), Score 3 = 72% (high risk), Score 4 = 97% (very high risk), and Scores 5-6 = 100% (very high risk). These estimates help guide clinical decision-making and family discussions about prognosis.
Can the ICH Score be used for all types of stroke?
No. The ICH Score is specifically designed for spontaneous (non-traumatic) intracerebral hemorrhage, which accounts for 10-15% of all strokes. It should not be used for ischemic stroke, subarachnoid hemorrhage, or traumatic intracranial hemorrhage. The score is most reliable when calculated within the first 24 hours of presentation.
Is the ICH Score used in India, the US, and the UK?
Yes, the ICH Score is used worldwide including in India, the United States, and the United Kingdom as a validated prognostic tool for intracerebral hemorrhage. It is included in major international guidelines such as those from the American Heart Association/American Stroke Association (AHA/ASA) and the European Stroke Organisation (ESO) for prognostication and clinical communication.
Should treatment decisions be based solely on the ICH Score?
No. The ICH Score is one of several clinical tools used for prognostication and should never replace comprehensive clinical assessment by a qualified healthcare professional. Treatment decisions must consider the full clinical picture including imaging findings, comorbidities, patient preferences, and the risk of self-fulfilling prophecy where early withdrawal of care based on a high score may worsen outcomes.
What is the ABC/2 method for ICH volume?
The ABC/2 method is the standard technique for estimating ICH volume on CT scan. A is the largest hemorrhage diameter (cm), B is the perpendicular diameter (cm), and C is the number of CT slices showing hemorrhage multiplied by slice thickness (cm). The volume is calculated as (A × B × C) / 2. A separate ICH Volume Calculator is available on this site for this calculation.
What are the limitations of the ICH Score?
The ICH Score was derived from a retrospective cohort and may not account for modern intensive care advances, hematoma evacuation, or individual patient factors such as do-not-resuscitate orders that influence mortality. The score should be used as a communication and risk-stratification tool, not as an absolute predictor of individual outcomes. More recent scores like the ICH-GS and FUNC score offer additional prognostic dimensions.