Prognostic Value of Intracerebral Hemorrhage Score in Patients with Spontaneous Intracerebral Hemorrhage

  • Karrar Hammoodi Hadi Division of Emergency, Baghdad teaching hospital, Medical City, Baghdad, Iraq.
  • Nawfal Madhi Sheaheed Director, Division of Neurology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq.
  • Ali Kadim Karim Division of Neurology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq.
  • Jawad Ibrahim Rasheed Nursing Home hospital, Medical City, Baghdad, Iraq.


Objective: to assess the performance and validity of ICH score in prediction of 30-day mortality as an outcome of patients with spontaneous ICH.
Methods: A prospective study was conducted in the emergency department of Baghdad teaching hospital during the period from 1st of May 2014 to the end of March 2015. A sample of 45 patients presented with non-traumatic ICH was included. Assessment of the patients with ICH scoring was performed and the total ICH score was calculated for each patient, patients followed up for 30 days and the mortality was reported. The 30-day mortality then compared with the ICH scores.
Results: The ICH score for the studied group ranged 1-5, no patients with score 0 or 6. Mortalities reported among patients at each score was 11.1% in those with score 1, 30% in score 2, 85.7% in score 3, 88.9% in score 4 and 100 in score 5. A strong direct significant correlation had been found between ICH score and 30-day mortalities. A progressive increase in the mortalities with the increase in the ICH score (r=0.75, P<0.001), lower Glasgow coma scale, the presence of IVH, ICH volume ≥30 ml, and age of > 80 years were significantly correlated with higher 30-days mortalities (P<0.05).
Conclusion: Higher mortality rates were reported in patients with higher ICH score. The ICH score is a good prognostic tool had an excellent performance in, predicting the 30-day mortality in patients with spontaneous ICH.
share this Article by


1. Qureshi AI, Mendelow AD, Hanley DF. Intracerebral hemorrhage. Lancet. 2009;373:1632–44.
2. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N. Engl. J. Med.2001;344:1450–60.
3. Fogelholm R, Murros K, Rissanen A, S Avikainen. Long-term survival after primary intracerebral hemorrhage: a retrospective population-based study. J Neurol Neurosurg Psychiatry. 2005; 76: 1534-8.
4. Brott T, Broderick J, Kothari R, Barsan W, Tomsick T, Sauerbeck L, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28:1-5.
5. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993; 24: 987–93.
6. Kazui S, Naritomi H, Yamamoto H, Sawada T, Yamaguchi T. Enlargement of spontaneous intracerebral hemorrhage: incidence and time course. Stroke. 1996;27:1783-7
7. Kazui S, Minematsu K, Yamamoto H, Sawada T, Yamaguchi T. Predisposing factors to enlargement of spontaneous intracerebral hematoma. Stroke. 1997;28:2370-5.
8. Leira R, Davalos A, Silva Y, Gil-Peralta A, Tejada J, Garcia M, et al. Stroke Project, Cerebrovascular Diseases Group of the Spanish Neurological Society. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology 2004 Aug 10;63(3):461-7.
9. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke Apr 2001;32(4):891-7
10. Rost NS, Smith EE, Chang Y, Snider RW, Chanderraj R, Schwab K, et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke 2008; 39(8): 23049.
11. Morgenstern LB, Hemphill JC, 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2010; 41:2108-29.
12. 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.
13. Shaya M, Dubey A, Berk C, Eduardo Gonzalez-Toledo, John Zhang, Gloria Caldito, et al. Factors influencing outcome in intracerebral hematoma: a simple, reliable, and accurate method to grade intracerebral hemorrhage. Surg Neurol 2005; 63:343-8. 78
14. Fernandes H, Gregson BA, Siddique MS, Mendelow AD (2002) Testing the ICH score. Stroke 33: 1455-1456
15 . Jamora R. D. G., Kishi-Generao E. M., Bitanga E. S., Gan R. N., Apaga N. E. P., San Jose, M. C. Z. The ICH score: predicting mortality and functional outcome in an Asian population. Stroke,2003; 34(1), 6-7.‏
16. Patriota GC, Silva-Júnior JM, Barcellos AC, Silva Júnior JB, Toledo DO, Rotta J. M. Determining ICH Score: can we go beyond? ArqNeuroPsiquiatr 2009; 67 (3): 605-608.
17. Godoy DA, Boccio A (2003) ICH score in a rural village in the Republic of Argentina. Stroke 34: e150-e151.
18. Hwang BY, Appelboom G, Kellner CP, Carpenter AM, Kellner MA, Gigante PR, et al. (2010) Clinical grading scales in intracerebral hemorrhage. Neurocrit Care13:141-151.
19. Cheung RT, Zou LY . Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage. Stroke, 2003; 34: 1717-1722.
20. Wang W, Lu J, Wang C, Wang Y, Li H, Zhao X. (2013) Prognostic Value of ICH Score and ICH-GS Score in Chinese Intracerebral Hemorrhage Patients: Analysis From the China National Stroke Registry (CNSR). PLoS ONE 8(10): e77421 .
21. Muengtaweepongsa S., Seamhan B. Predicting mortality rate with ICH score in Thai intracerebral hemorrhage patients. Neurology Asia, 2013; 18(2), 131-135.
22. van Asch CJJ, Luitse MJA, Rinkel GJE, van der Tweel I, Algra A, Klijn CJM. Incidence, case fatality, and functional outcome of intracerebral hemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010; 9:167-76.
23. Zhang L-F, Yang J, Hong Z, Yuan GG, Zhou BF, Zhao LC, et al. Proportion of different subtypes of stroke in China. Stroke 2003;34:2091-6.
24. Yousuf RM, Fauzi ARM, Jamalludin AR, How SH, Amran M, Shahrin TCA, et al. Predictors of in-hospital mortality in primary intracerebral hemorrhage in East coast of Peninsular Malaysia. Neurol Asia 2012; 17(2):93-9.
25. Hemphill JC, 3rd, Farrant M, Neill TA, Jr. Prospective validation of the ICH Score for 12-month functional outcome. Neurology 2009; 73:1088-94.
26. Wang CW, Liu YJ, Lee YH, Hueng DY, Fan HC, Yang FC, et al. (2014). Hematoma Shape, Hematoma Size, Glasgow Coma Scale Score and ICH Score: Which Predicts the 30-Day Mortality Better for Intracerebral Hematoma? PLoS One 2014 Jul 16;9(7):e102326
27. Peng SY, Chuang YC, Kang TW, Tseng KH. Random forest can predict 30‐day mortality of spontaneous intracerebral hemorrhage with remarkable discrimination. Eur J Neurol 2010 Jul;17(7):945-50
28. Chuang Y. C., Chen Y. M., Peng S. K., Peng, S. Y. Risk stratification for predicting 30-day mortality of intracerebral hemorrhage. International Journal for Quality in Health Care 2009; 21(6), 441-447.‏
29. Stein M, Luecke M, Preuss M, Scharbrodt W, Joedicke A, Oertel MF. The prediction of 30-day mortality and functional outcome in spontaneous intracerebral hemorrhage with secondary ventricular hemorrhage: a score comparison. Acta Neurochir Suppl 2011;112:9-11
30. Godoy DA, Piñero G, DiNapoli M. Predicting Mortality in Spontaneous Intracerebral Hemorrhage Can Modification to Original Score Improve the Prediction? Stroke 2006; 37(4), 1038-1044.‏
31. Magistris F, Bazak S, Martin J. Intracerebral hemorrhage: pathophysiology, diagnosis and management. MUMJ 2011; 10(1), 15-22.
How to Cite
HADI, Karrar Hammoodi et al. Prognostic Value of Intracerebral Hemorrhage Score in Patients with Spontaneous Intracerebral Hemorrhage. Iraq Medical Journal, [S.l.], v. 3, n. 1, feb. 2019. ISSN 2521-8492. Available at: <>. Date accessed: 16 june 2019.