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ICH Score (Intracerebral Hemorrhage)

The ICH score (0–6) predicts 30-day mortality after spontaneous intracerebral haemorrhage from GCS, hematoma volume ≥30 mL, intraventricular extension, infratentorial origin and age ≥80. Observed 30-day mortality: 0 = 0%, 1 = 13%, 2 = 26%, 3 = 72%, 4 = 97%, 5 = 100%.

GCS on presentation
ICH volume (ABC/2)
Intraventricular hemorrhage (yes/no, +1)
Infratentorial origin (yes/no, +1)
Age (years)

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Interpretation

Result	Meaning
0	0%
1	13%
2	26%
3	72%
4	97%
5	100%
6	none in derivation; predicted ~100%

Formula

GCS 3–4: 2, 5–12: 1, 13–15: 0 · Volume ≥30 mL: 1 · IVH: 1 · Infratentorial origin: 1 · Age ≥80: 1

Clinical pearls

Derived in 152 patients with spontaneous (non-traumatic) ICH; not for traumatic, aneurysmal or tumour-related bleeds.
Early DNR orders can make mortality a self-fulfilling prophecy; guidelines advise full care for at least the first day rather than withdrawing on the score alone.
Volume by ABC/2: A × B × C ÷ 2 in cm on CT gives mL.

Examples

ich score gcs 10, 40 ml, ivh present, supratentorial, 72 yo intracerebral hemorrhage mortality for an 85 year old with GCS 14, 20 mL cerebellar bleed, no IVH

FAQ

How is ICH volume estimated?

ABC/2: largest diameter A, perpendicular diameter B, and number of slices × slice thickness C (all in cm); A×B×C/2 ≈ volume in mL.

What does an ICH score of 3 mean?

About 72% 30-day mortality in the derivation cohort.

Evidence

Hemphill JC 3rd et al. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001;32:891–7.

Neurology · Reviewed 2026-10-14 · Methodology