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    Patent Pending

    Functional Outcome in Patients With Primary Intracerebral Hemorrhage (FUNC) Score

    Identifies patients with ICH who will attain functional independence and assists in clinical decision-making.
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    INSTRUCTIONS

    Use when the diagnosis of ICH is made, NOT as a continuously changing marker of neurologic status as GCS is used. Use only in patients with primary ICH. Do not use in patients with ICH from trauma, conversion from ischemic stroke, supratherapeutic INR (see Evidence section for full exclusion criteria).

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients diagnosed with ICH.
    • Grades ICH severity and subsequent likelihood of functional independence at 90 days, thus helping to guide goals of care conversations with patients’ families.
    • Often used in conjunction with the ICH score, which predicts 30 day mortality after ICH.
    • The Functional Outcome in Patients With Primary Intracerebral Hemorrhage (ICH) Score estimates likelihood of functional independence after a diagnosis of ICH.
    • It is intended to be used when the diagnosis of ICH is made, NOT as a continual marker of the patient’s prognosis throughout their stay.
    • While the score can be a marker for ICH severity, it is typically NOT used to guide treatment modality.
    • It should be used in patients with primary ICH only. Do not use in patients with secondary causes of ICH such as vascular malformation, CNS tumor, antecedent trauma or ischemic stroke, vasculitis, supratherapeutic INR (>3.0), or bleeding disorder.
    • Helps clinicians quickly and accurately prognosticate patients admitted for ICH.
    • Can be used as a tool to help guide goals of care decisions.
    About the Creator
    Dr. Natalia S. Rost
    Content Contributors
    • Nikhil Patel, MD

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • While the ICH score grades severity of the disease, it does not directly dictate treatment modalities.
    • Patients with ICH should have emergent consultation with neurosurgery and be stabilized prior to transfer, if transfer is required. Most patients require ICU-level care and monitoring for airway sequelae of neurologic decompensation.
    • ICH often causes hydrocephalus; therefore, patients with low GCS and/or signs of hydrocephalus on head CT may also need urgent ventricular decompression with an extra-ventricular drain (EVD).
    • Coagulation studies should be ordered immediately to determine if any coagulopathy is contributing to ongoing bleeding. Clinicians should also determine if aspirin or other antiplatelet medications were taken by the patient.

    Management

    Clinical decisions regarding goals of care should not be made solely based on FUNC score.  Other factors such as patients’ and families’ wishes, baseline neurologic status, and other co-morbidities should be taken into consideration.

    Critical Actions

    • Patients on antiplatelet agents or anticoagulation may require reversal agents.
    • Patients with ICH that may require intervention should be emergently transferred to a facility with neurosurgical capabilities, if not present at the admitted facility.

    Formula

    Addition of assigned points.

    Facts & Figures

    Score interpretation:

    FUNC Score Functional Independence at 90 Days
    0 - 4 0%
    5 - 7 1-20%
    8 21-60%
    9 - 10 61-80%
    11 81-100%

    Evidence Appraisal

    • The FUNC score was developed to provide more detailed prognostic information for patients with ICH. Unlike the ICH score, which focuses on predicting 30-day mortality, this score focused on predicting functional independence at 90 days, defined as a Glasgow Outcome Scale > 4.
    • The score was developed by Rost et al in 2008 using retrospective data that was in prospectively validated in 629 consecutive patients presenting with ICH. At 90 days, 26% of patients had functional independence.
    • In the original data set, only patients with primary ICH were included. Patients with any of the following were excluded:
      • Vascular malformation
      • CNS tumor
      • Antecedent trauma
      • Ischemic stroke
      • Vasculitis
      • Excessive anticoagulation (INR >3.0)
      • Any blood dyscrasia
    • Garrett et al in 2013 validated the FUNC score in a retrospective cohort of 501 patients, and found that it performed similarly or or better than alternative scores: the AUC for FUNC was 0.873, similar to 0.888 for ICH-GS and better than 0.743 for oICH.
    Dr. Natalia S. Rost

    About the Creator

    Natalia S. Rost is an Associate Professor of Neurology at Harvard Medical School. She is also the Director, Acute Stroke Service and the Acute Stroke Quality Taskforce at the Massachusetts General Hospital. Dr. Rost's research interests and expertise include neuroimaging of cerebrovascular disease, genetics and genomics of stroke, and outcome prediction in patients with acute stroke.

    To view Dr. Natalia S. Rost's publications, visit PubMed

    Content Contributors
    • Nikhil Patel, MD