ICH score: how the points are calculated

The ICH score adds up points for five items in a person with an intracerebral hemorrhage (bleeding into the brain): Glasgow Coma Scale total (2 points for 3–4, 1 for 5–12, 0 for 13–15), age 80 or older (1), bleeding that starts below the tentorium (1), a bleed volume of 30 mL or more (1), and blood in the ventricles (1). The total runs from 0 to 6. A GCS of 12 with no other items scores 1.

Not a medical device. Not a diagnosis or dosing recommendation.

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What is the ICH score?

The ICH score is a grading scale for intracerebral hemorrhage (ICH), published by J. Claude Hemphill III and colleagues in Stroke in 2001. The paper's title calls it "a simple, reliable grading scale." It's sometimes called the Hemphill ICH score or the ICH grading scale.

It uses five things the abstract says allow grading when a person first presents with ICH: the Glasgow Coma Scale, age, where the bleed started, how big it is, and whether blood has reached the ventricles.

This page explains the arithmetic. It doesn't give a cutoff, it doesn't turn a score into an outcome percentage, and it doesn't say what a score means for a particular person.

The ICH score formula

ICH score = GCS points (0–2) + age ≥ 80 (1) + infratentorial origin (1)
          + volume ≥ 30 mL (1) + intraventricular hemorrhage (1)
maximum = 6

Exact expression the calculator uses:

ICH Score = gcs + age_ge_80 + infratentorial_origin + ich_volume_ge_30_ml + ivh; GCS 3-4 → 2, 5-12 → 1, 13-15 → 0; age >=80 1; infratentorial origin 1; volume >=30 mL 1; IVH 1; max 6

What each part means

Item	What earns points	Points
Glasgow Coma Scale (GCS)	3 or 4	2
	5 to 12	1
	13 to 15	0
Age	80 or older	1
Infratentorial origin	The bleed started below the tentorium (brainstem or cerebellum)	1
ICH volume	30 mL (cm³) or more	1
Intraventricular hemorrhage (IVH)	Blood in the ventricles	1

How the score works

GCS. Use the total GCS, from 3 to 15. 3–4 earns 2 points, 5–12 earns 1, and 13–15 earns 0.
Age. 80 or older earns 1 point; 79 earns nothing.
Origin. If the bleed started below the tentorium, add 1.
Volume. If the bleed is 30 mL or more, add 1. 29.9 mL doesn't count.
IVH. If there's blood in the ventricles, add 1.
Add them up. The total is 0 to 6.

Inputs come from the user

The record says every input is supplied by the person using the calculator. Magent's calculator doesn't read a CT scan, measure the bleed, or work out the GCS from eye, verbal and motor parts. It takes a GCS total from 3 to 15, age from 18 to 120, and a volume from 0.1 to 300 mL, and returns the total, the maximum of 6, and a line for each item. It doesn't return an outcome table.

Worked examples

These use Magent's own expected values for the calculator.

Example 1: no items

GCS 15 → 0; age 70 → 0; not infratentorial → 0.
Volume 10 mL → 0; no IVH → 0.
Score = 0.

Example 2: GCS 12

GCS 12 is in the 5–12 range → 1.
Age 70, 10 mL, no other items → 0.
Score = 1.

Example 3: GCS 4

GCS 4 is in the 3–4 range → 2.
Score = 2.

Example 4: volume right at 30 mL

GCS 15, age 70; volume 30.0 mL → 1.
Score = 1. At 29.9 mL the same person scores 0.

Example 5: every item

GCS 3 → 2; age 80 → 1; infratentorial → 1.
Volume 30 mL → 1; IVH → 1.
Score = 6, the maximum.

ICH score edge-value table

Each row changes one item from a baseline of GCS 15, age 70, a 10 mL supratentorial bleed and no IVH. All are Magent's expected values for the calculator.

What changed	Score
Nothing (baseline)	0
GCS 13	0
GCS 12	1
GCS 5	1
GCS 4	2
Age 79	0
Age 80	1
Infratentorial origin	1
Volume 29.9 mL	0
Volume 30.0 mL	1
IVH present	1

History of the ICH score

The score comes from J. Claude Hemphill III, David C. Bonovich, Lavrentios Besmertis and colleagues, The ICH score: a simple, reliable grading scale for intracerebral hemorrhage, Stroke 2001 (volume 32, issue 4, pages 891–897).

The abstract notes that ICH makes up 10% to 15% of all strokes, and that unlike traumatic brain injury, subarachnoid hemorrhage and ischemic stroke, it had no standard clinical grading scale. The authors studied the records of everyone with acute ICH at the University of California, San Francisco during 1997–1998. They found the factors independently linked with outcome at 30 days and gave each one points based on how strong the link was. The five factors were GCS, age 80 or older, infratentorial origin, ICH volume, and IVH.

When it's used

The 2001 abstract describes the ICH score as a simple clinical grading scale used when a person first presents with ICH.

Where it's used

The abstract suggests that using a scale such as the ICH score could improve standardization in clinical protocols and in clinical research on ICH.

Who uses it

The record says the GCS, volume, IVH and origin are assigned by the person using the calculator; Magent doesn't read a CT scan. The calculator does the adding.

Limits of the calculation

It adds up five items. It doesn't diagnose a bleed or read imaging.
It's the Hemphill 2001 ICH score, not the FUNC score and not ICH-GS.
The GCS is entered as a total; the calculator doesn't add up eye, verbal and motor parts.
The calculator returns the point total, not an outcome percentage.
This page doesn't say what to do with a score.

Clinical decisions belong to a qualified clinician who knows the patient.

How it differs from related calculators

Glasgow Coma Scale adds eye, verbal and motor responses into the GCS total that the ICH score uses as one input.
ABC/2 estimates a bleed volume in mL from three measurements. That volume is the kind of number the ICH score's volume item asks for.

Glossary

Intracerebral hemorrhage (ICH): bleeding inside the brain tissue.
Glasgow Coma Scale (GCS): a 3 to 15 total for eye, verbal and motor responses.
Tentorium: a sheet of tissue separating the upper brain from the cerebellum and brainstem below it.
Infratentorial: below the tentorium.
Intraventricular hemorrhage (IVH): blood inside the brain's fluid-filled ventricles.
mL / cm³: the same unit of volume.

Common mistakes

Giving GCS 13 a point. 13–15 scores 0; 5–12 scores 1.
Rounding 29.9 mL up. The volume point starts at 30 mL.
Entering eye, verbal and motor parts. The input is the GCS total.
Mixing up infratentorial and supratentorial. The point is for bleeds that start below the tentorium.

Source

Hemphill JC 3rd, 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. DOI: 10.1161/01.STR.32.4.891

Frequently asked questions

How do you calculate the ICH score?

Give 2 points for GCS 3–4 or 1 for GCS 5–12, then 1 each for age 80 or older, infratentorial origin, a volume of 30 mL or more, and IVH. The total is 0 to 6.

What does an ICH score of 3 mean?

This page doesn't give a cutoff or an outcome by score. It adds up the points; what a score means depends on the person and the clinical context.

What is the highest ICH score?

6, with every item present.

How is the ICH volume measured?

The calculator doesn't measure it; it takes a volume in mL from the user. The ABC/2 method is one way to estimate it from imaging measurements.

Does a GCS of 13 score a point?

No. GCS 13 to 15 scores 0.

Who developed the ICH score?

J. Claude Hemphill III and colleagues at the University of California, San Francisco, in a 2001 Stroke paper.