Intracerebral Hemorrhage (ICH) Score
- The ICH score allows for a standardized and consistent clinical grading scale for ICH, thus improving communication among clinicians.
- The ICH score grades ICH severity and subsequent 30-day mortality, thus helping to guide goals of care conversations with patients’ families.
- This score is often used in conjunction with the FUNC score, which indicates the likelihood of a patient’s functional independence 90 days after ICH.
- While the score can be a marker for ICH severity, it is typically not used to guide treatment modality.
- The ICH Score allows clinicians with varying level of training and clinical backgrounds to grade ICH severity in a succinct, universal manner.
- The ICH Score is intended to be used after the diagnosis of ICH is made, and is generally not used as a continual marker of the patient’s neurologic status (such as the GCS).
- The score is sometimes criticized as physicians and families had previously used gestalt to make the decision to withdraw care, and that this bias may have affected the validation.
- Please note that the ICH score is primarily used as a clinical grading scale and communication tool. It is not meant to provide prognostic information, and should not be used as a primary means to predict the outcomes of patients with ICH.
This tool helps clinicians quickly and accurately prognosticate patients who are admitted for ICH, and can be used as a tool to help decide the appropriate level of care and/or transfer.
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- 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. Platelet administration is NOT recommended in the setting of antiplatelet-related ICH, based on data from the PATCH trial.
- AHA guidelines recommend lowering systolic BP to <160 mmHg, usually achieved with IV antihypertensives.
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.
- 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.
- Nikhil Patel, MD
- Benjamin Kummer, MD