The ICH score - A simple, reliable grading scale for intracerebral hemorrhage

Background and Purpose-Intracerebral hemorrhage (ICH) constitutes 10% to 15 % of all strokes and remains without a treatment of proven benefit. Despite several existing outcome prediction models for ICH, there is no standard c linical grading scale for ICH analogous to those for traumatic brain injury , subarachnoid hemorrhage, or ischemic stroke. Methods-Records of all patients with acute ICH presenting to the University of California, San Francisco during 1997-1998 were reviewed. Independent p redictors of 30-day mortality were identified by logistic regression. A ris k stratification scale (the ICH Score) was developed with weighting of inde pendent predictors based on strength of association. Results-Factors independently associated with 30-day mortality were Glasgow Coma Scale score (P<0.001), age <greater than or equal to>80 years (P=0.00 1), infratentorial origin of ICH (P=0.03), ICH volume (P=0.047), and presen ce of intraventricular hemorrhage (P=0.052). The ICH Score was the sum of i ndividual points assigned as follows: GCS score 3 to 4 (=2 points), 5 to 12 (=1), 13 to 15 (=0); age greater than or equal to 80 years yes (=1), no (= 0); infratentorial origin yes (=1), no (=0); ICH volume greater than or equ al to 30 cm(3) (=1), <30 cm(3) (=0); and intraventricular hemorrhage yes (= 1), no (=0). All 26 patients with an ICH Score of 0 survived, and all 6 pat ients with an ICH Score of 5 died. Thirty-day mortality increased steadily with ICH Score (P<0.005). Conclusions-The ICH Score is a simple clinical grading scale that allows ri sk stratification on presentation with ICH. The use of a scale such as the ICH Score could improve standardization of clinical treatment protocols and clinical research studies in ICH.