π§ ICH Score Calculator
The validated Hemphill ICH Score, scored in seconds.
For informational purposes only, not medical advice. Consult a healthcare professional.
The ICH Score predicts 30-day mortality after intracerebral hemorrhage from five bedside facts: Glasgow Coma Scale, bleed volume, whether blood entered the ventricles, whether the bleed started below the tentorium, and whether the patient is 80 or older. Each adds 0 to 2 points for a total of 0 to 6. Published mortality runs from 0% at a score of 0 to 100% at scores of 5 and 6.
It was derived by Hemphill and colleagues and published in Stroke in 2001, then validated in separate cohorts, which is why it remains the standard bedside grading scale for hemorrhagic stroke. It does not decide treatment on its own. Surgeons and neurologists combine it with the clinical picture, but families often hear the number first, so knowing what each point means keeps the conversation honest.
How to Use This Calculator
Enter the five components from the CT report and the bedside exam. GCS comes from the neurological exam (eye, verbal, and motor responses). Bleed volume usually comes from the radiologist using the ABC/2 method. IVH means blood is visible in the ventricles. Infratentorial means the bleed started in the cerebellum or brainstem rather than the cerebral hemispheres. Age is straightforward.
Pick the GCS band that matches the exam: 13 to 15, 5 to 12, or 3 to 4.
Enter the bleed volume in cubic centimeters from the CT report.
Answer yes or no for intraventricular blood and for infratentorial origin.
Enter the age and read the score plus the published 30-day mortality for that score.
How the ICH Score Is Built
+ infratentorial (0-1) + age >= 80 (0-1)
Each component earned its place because it independently predicted death in the derivation cohort. Low GCS reflects how badly the bleed has already hurt brain function. Volume at or above 30 cubic centimeters marks the point where mass effect and pressure become dangerous. Blood in the ventricles signals a larger, more destructive bleed and risks hydrocephalus. Infratentorial bleeds threaten the brainstem directly. Age 80 or older captures reduced reserve. The mortality figures come from the original study: 0% for 0 points, 13% for 1, 26% for 2, 72% for 3, 97% for 4, and 100% for 5 or 6. Later validations found the same steep climb even if exact percentages shifted slightly by population.
Worked Example
A 82-year-old with a GCS of 8, a 35 cm3 bleed, and blood in the ventricles scores 4 / 6: one point each for GCS 5 to 12, volume at or above 30 cm3, IVH present, and age 80 or older. The published 30-day mortality for that score is 97%. A milder case, GCS 14 with a 12 cm3 bleed and no IVH in a 65-year-old, scores 0, where the published mortality was 0%.
How to Read Your ICH Score
Scores of 0 to 1 carry low published mortality and usually mean aggressive care continues while the team watches for expansion. A score of 2 sits in the middle at about one in four, which is where goals-of-care conversations typically start in earnest. Scores of 3 and above carry high to very high mortality, and the score is often cited when families and teams discuss whether surgery or continued intensive care fits the patient's wishes. Remember that the score describes groups, not individuals: a score of 3 means about 7 in 10 similar patients died within 30 days, not that any one patient has a 72% personal chance in a precise sense.
| Score | Published 30-day mortality | Typical reading |
|---|---|---|
| 0 | 0% | Low risk |
| 1 | 13% | Low risk |
| 2 | 26% | Moderate risk |
| 3 | 72% | High risk |
| 4 | 97% | Very high risk |
| 5-6 | 100% | Very high risk |
This Score Supports Clinicians, Not Families Alone
The ICH Score is a clinical grading tool built from hospital data, and it is most useful in the hands of the stroke team caring for the patient. If you are a family member looking at this number, bring it to the neurologist or neurosurgeon and ask what it means alongside the scan and the exam. Early bleeds can expand in the first hours, so a score calculated at admission can change. For informational purposes only, not medical advice. Consult a healthcare professional.
Related tools: ICH bleed volume (ABC/2) calculator, NIH Stroke Scale and mean arterial pressure target.
For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
What is a good ICH Score?
Lower is better. Scores of 0 to 1 carry published 30-day mortality of 0 to 13 percent, while scores of 5 to 6 approached 100 percent in the original study. Most clinicians treat 0 to 2 as the range where aggressive care is clearly reasonable.
Can the ICH Score improve over time?
The score itself is calculated at presentation and does not get recalculated as a new number, but the patient can absolutely do better or worse than the group average. Early hematoma expansion, hydrocephalus, and medical complications move individual outcomes.
What GCS counts for the ICH Score?
The scale uses bands, not the raw number: GCS 13 to 15 scores 0 points, 5 to 12 scores 1, and 3 to 4 scores 2. A GCS of 8, the classic intubation threshold, falls in the middle band.
Why does 30 cm3 matter for bleed volume?
In the derivation study, 30 cubic centimeters was the cutoff that separated survivors from non-survivors most cleanly. Above it, mass effect, midline shift, and herniation risk climb sharply. Our ICH volume calculator shows how radiologists measure it with ABC/2.
What is intraventricular hemorrhage (IVH)?
Blood that has broken through into the brain's ventricles, the fluid-filled spaces. It adds a point because it marks a larger bleed and can block cerebrospinal fluid flow, causing hydrocephalus.
Is the ICH Score used to decide on surgery?
It informs the discussion but never decides alone. Surgeons weigh the score alongside the bleed location, the patient's exam trend, age, prior wishes, and whether the bleed is expanding. A high score prompts an honest prognosis talk, not an automatic no.
How accurate is the ICH Score?
It validated well in separate populations, with the same steep mortality climb by score. Like all group-derived scores, it is less precise for any single patient, and modern care has nudged some outcomes better than the 2001 figures.
Does infratentorial location really add a full point?
Yes. Bleeds in the cerebellum or brainstem threaten breathing and consciousness centers directly and have less room to expand before causing damage, so they carry disproportionate risk for their size.