ICH Score Calculator (intracerebral haemorrhage grading, Hemphill 2001)

Understanding the ICH score calculator — concept and principle

The ICH score grades the severity of a spontaneous intracerebral haemorrhage (bleeding into the brain) using five findings available on admission. It was introduced by Hemphill and colleagues in 2001 and is used by emergency, neurology and neurosurgery teams to communicate severity and in research.

How it is calculated

ICH score (0–6) = GCS points + volume point + ventricle point + location point + age point

• Glasgow Coma Scale 3–4 → 2 points; 5–12 → 1; 13–15 → 0.
• Haematoma volume 30 mL or more → 1.
• Blood in the ventricles (intraventricular haemorrhage) → 1.
• Bleed starting below the tentorium (cerebellum or brainstem) → 1.
• Age 80 or older → 1.

The principle

In the 152-patient derivation study, these five factors each independently predicted death within 30 days. Lower consciousness reflects the impact of the bleed on the whole brain; a large volume and blood in the ventricles reflect the amount of damage and risk of hydrocephalus; bleeds in the brainstem or cerebellum press on vital structures in a small space; and older age reduces the brain's reserve. Simple points make the score fast and reliable between raters.

Worked example

Default inputs: GCS 11, volume 35 mL, blood in the ventricles, not infratentorial, age 72.

1. GCS 11 is in 5–12 → 1 point.
2. Volume 35 mL ≥ 30 → 1 point.
3. Intraventricular blood → 1 point.
4. Supratentorial → 0; age 72 → 0.
5. ICH score = 3.

How to read the result

In the original study, 30-day mortality rose steadily with each point: all 26 patients with a score of 0 survived and all 6 with a score of 5 died. The score describes severity on admission; it does not decide whether to treat, and early limits on care can themselves raise mortality, so modern guidelines advise full care at first.

Common mistakes

• Scoring GCS after sedation or intubation without noting it.
• Estimating volume by eye instead of using ABC/2.
• Using the score for bleeding caused by trauma, which was not included.

Frequently asked questions

How is haematoma volume measured?

Usually with the ABC/2 method on the CT scan, which multiplies three diameters and halves the result.

Is a score of 3 always serious?

It indicates a severe bleed, but outcomes vary widely and depend on treatment and other factors.

Are there newer scores?

Yes, several modified versions exist, but the original ICH score remains the most widely used.

Sources: Hemphill JC III, Bonovich DC, Besmertis L, Manley GT, Johnston SC, "The ICH score: a simple, reliable grading scale for intracerebral hemorrhage", Stroke 2001;32(4):891–897