Intracerebral Hemorrhage (ICH) Score

id

402

full_title

Intracerebral Hemorrhage (ICH) Score

short_title

Intracerebral Hemorrhage (ICH) Score

med_description

Estimates mortality in ICH based on age and CT findings.

description

The Intracerebral Hemorrhage (ICH) Score estimates mortality based on age and CT findings.

keywords

ICH score, Intracerebral hemorrhage score, Intracerebral hemorrhage calc, Intracerebral bleed score, Intracerebral bleed calc, intracerebral stroke calc, stroke ICH, stroke ICH score, mortality ICH score, prognosis ICH, prognosis ICH score, CT findings mortality score, mortality stroke score.

complaint

[ "Headache" ]

formula

evidence

The ICH score was developed to provide a clinical grading scale for ICH that helps standardize clinical treatment protocols and clinical research studies in ICH. The score was developed at UCSF, with the original study analyzing 161 patients presenting with ICH to UCSF between 1997-1998. Overall, the analysis helps provide information about the degree of severity of ICH as well as 30-day mortality rates that helped guide decision-making.

measurements

[]

information

Score interpretation:

*No patients in study score 6, but estimates 100%.

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/11283388", "text": "Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001 Apr;32(4):891-7. PubMed PMID: 11283388." } ], "Other References": [ { "href": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30392-0/abstract", "text": "Baharoglu MI, Cordonnier C, Al-shahi salman R, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet. 2016;387(10038):2605-13." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/16174898", "text": "Clarke JL, Johnston SC, Farrant M, Bernstein R, Tong D, Hemphill JC 3rd. External validation of the ICH score. Neurocrit Care. 2004;1(1):53-60." } ], "Validations": [] }

pearls

• 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.

usecase

• 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.

reasons

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.

next_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. 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.

next_actions

• Attention should be paid to patients on anti-platelet agents or anticoagulation as often as 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.

next_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.

diseases

[ "Intracranial Hemorrhage", "Stroke/TIA", "Subarachnoid Hemorrhage" ]

instructions

published

2022-04-21T20:29:37.180Z

purpose

[ "Prognosis" ]

search_terms

[ "ich", "cva", "stroke", "tia", "ich score", "tpa" ]

seo

{ "keywords_en": "ICH score, Intracerebral hemorrhage score, Intracerebral hemorrhage calc, Intracerebral bleed score, Intracerebral bleed calc, intracerebral stroke calc, stroke ICH, stroke ICH score, mortality ICH score, prognosis ICH, prognosis ICH score, CT findings mortality score, mortality stroke score.", "meta_description_en": "The Intracerebral Hemorrhage (ICH) Score estimates mortality based on age and CT findings." }

specialty

[ "Critical Care", "Critical Care (Neurologic)", "Emergency Medicine", "Hospitalist Medicine", "Neurology", "Neurosurgery", "Radiology", "Surgery (General)", "Surgery (Trauma)" ]

departments

[ "Neurologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 2031, "short_title_en": "ABC/2 Formula", "slug": "abc2-formula-intracerebral-hemorrhage-volume" }, { "calcId": 3802, "short_title_en": "sICH Score", "slug": "secondary-intracerebral-hemorrhage-sich-score" }, { "calcId": 1934, "short_title_en": "tPA Contraindications", "slug": "tpa-contraindications-ischemic-stroke" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "neurology" ]

cleaned_use

[ "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." ]

pub

true