Interactive ICH Score Calculator
Use this tool to estimate the Intracerebral Hemorrhage (ICH) Score from common clinical inputs.
What is the ICH score?
The ICH score is a bedside prognostic tool used after spontaneous intracerebral hemorrhage. It combines a small set of clinical and imaging variables into a single number that helps clinicians estimate short-term mortality risk and communicate severity consistently.
It is not designed to replace clinical judgment. Instead, it provides a structured starting point for discussions around prognosis, level of monitoring, and early care planning.
How this ICH score calculator works
This calculator follows the classic point system:
- GCS 3–4: +2 points
- GCS 5–12: +1 point
- GCS 13–15: +0 points
- Age ≥ 80 years: +1 point
- ICH volume ≥ 30 mL: +1 point
- Intraventricular hemorrhage present: +1 point
- Infratentorial origin: +1 point
Total score ranges from 0 to 6. Higher scores are associated with higher observed mortality in the original and subsequent cohorts.
Scoring reference table
| ICH Score | Approximate 30-day mortality (original cohorts) |
|---|---|
| 0 | ~0% |
| 1 | ~13% |
| 2 | ~26% |
| 3 | ~72% |
| 4 | ~97% |
| 5 | ~100% |
| 6 | ~100% (rare) |
Input guide: getting each variable right
1) Glasgow Coma Scale (GCS)
Use the best documented GCS near initial assessment. Sedation, intubation, and paralytics can influence scoring, so context matters when interpreting results.
2) Age
The threshold is binary in this model: under 80 vs 80 and above. Enter exact age and the calculator applies the cutoff automatically.
3) Hematoma volume
In many settings, volume is estimated using the ABC/2 method on CT:
- A: largest hemorrhage diameter (cm)
- B: diameter perpendicular to A (cm)
- C: number of slices with hemorrhage × slice thickness (cm)
- Volume: A × B × C / 2
Enter the best available mL estimate; values at or above 30 mL add one point.
4) IVH and location
Mark whether intraventricular extension is present, and whether hemorrhage origin is infratentorial (brainstem/cerebellar region) versus supratentorial.
How to interpret the result responsibly
The ICH score is a population-derived prognostic model. It should be interpreted alongside:
- Neurologic trend over time
- Comorbid conditions and baseline function
- Anticoagulation status and reversal response
- Neurosurgical considerations
- Patient values and goals of care
Common pitfalls
- Using inaccurate volume estimates from incomplete imaging review
- Applying a single early GCS without considering sedation/confounders
- Over-interpreting mortality percentages as exact outcomes for individuals
- Ignoring dynamic changes in first 24–48 hours
Practical workflow in acute care
- Confirm hemorrhage diagnosis and key CT characteristics.
- Capture reliable initial GCS and age.
- Estimate hematoma volume and assess for IVH.
- Calculate ICH score.
- Combine score with serial exams and multidisciplinary input.
Frequently asked questions
Is a higher ICH score always predictive of poor outcome?
No. It indicates higher statistical risk, not certainty. Individual outcomes can vary meaningfully.
Can this calculator be used for traumatic hemorrhage?
The classic ICH score was developed for spontaneous intracerebral hemorrhage. Use caution when applying it outside that context.
Should treatment be limited based on this score alone?
No. Prognostic tools support, but do not replace, individualized clinical decision-making.