Functional Outcome in Patients With Primary Intracerebral Hemorrhage (FUNC) Score
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).
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- 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.
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.
- 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.
- Nikhil Patel, MD