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    Intracerebral Hemorrhage (ICH) Score

    Based on age and CT findings; estimates mortality.
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    Advice

    • While the ICH score grades severity of the disease, it does not directly affect treatment modalities.
    • Patients with intracerebral hemorrhage should have emergent consultation with neurosurgery and 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, thus 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 there is any coagulopathy that is contributing to ongoing bleeding. Clinicians should also determine if aspirin was taken by the patient, as this may require platelet transfusion to help achieve hemostasis.
    • AHA guidelines recommend lowering systolic BP to < 160 mmHg, usually achieved with IV antihypertensives.

    Management

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

    Critical Actions

    • Attention should be paid to patients on anti-platelet agents or anticoagulation as often these patients require reversal agents.
    • Patient’s with ICH should be emergently transferred to a facility with neurosurgical capabilities if not present at the admitted facility.
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