(Stroke. 2001;32:891.)
© 2001 American Heart Association, Inc.
Original Contributions |
The ICH Score
A Simple, Reliable Grading Scale for Intracerebral Hemorrhage
From the Departments of Neurology (J.C.H., D.C.B., L.B., S.C.J.) and Neurosurgery (G.T.M.), University of California, San Francisco.
Correspondence to J. Claude Hemphill III, MD, Department of Neurology, San Francisco General Hospital, Room 4 M62, 1001 Potrero Ave, San Francisco, CA 94110. E-mail jchiii{at}itsa.ucsf.edu
Background and Purpose—Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes and remains without a treatment of proven benefit. Despite several existing outcome prediction models for ICH, there is no standard clinical grading scale for ICH analogous to those for traumatic brain injury, subarachnoid hemorrhage, or ischemic stroke.
Methods—Records of all patients with acute ICH presenting to the University of California, San Francisco during 1997–1998 were reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the ICH Score) was developed with weighting of independent predictors based on strength of association.
Results—Factors
independently associated with 30-day mortality were Glasgow Coma Scale
score (P<0.001), age 
80
years (P=0.001), infratentorial
origin of ICH (P=0.03), ICH
volume (P=0.047), and presence
of intraventricular hemorrhage
(P=0.052). The ICH Score was
the sum of individual points assigned as follows: GCS score 3 to 4 (=2
points), 5 to 12 (=1), 13 to 15 (=0); age 80 years yes (=1), no (=0);
infratentorial origin yes (=1), no (=0); ICH volume 30
cm3 (=1), <30
cm3 (=0); and
intraventricular hemorrhage yes (=1), no
(=0). All 26 patients with an ICH Score of 0 survived, and all 6
patients with an ICH Score of 5 died. Thirty-day mortality increased
steadily with ICH Score
(P<0.005).
Conclusions—The ICH Score is a simple clinical grading scale that allows risk stratification on presentation with ICH. The use of a scale such as the ICH Score could improve standardization of clinical treatment protocols and clinical research studies in ICH.
Editorial Comment
A Simple, Reliable Grading Scale for Intracerebral Hemorrhage
Department of Neurology, Mount Sinai School of Medicine, New York, NY
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