ICH Calculator
Predict 30-day mortality risk in spontaneous intracerebral hemorrhage using the validated Hemphill ICH Score (0–6)
This calculator is for educational and clinical reference purposes only. The ICH Score is a grading and communication tool — it is NOT intended to be used as the sole basis for limiting or withdrawing aggressive treatment. Research has shown that early DNR orders based primarily on ICH scores may create self-fulfilling prophecies. Always integrate the ICH Score with the patient's expressed wishes, premorbid function, and the full clinical picture. Consult a qualified healthcare professional for all clinical decisions.
Glasgow Coma Scale (GCS)
Select the GCS range at presentation, or use the GCS calculator below to derive the total from sub-scores
Clinical Variables
Answer Yes or No for each variable based on the patient's presentation and imaging
Patient age 80 years or older at time of presentation (+1 point)
Hematoma volume 30 milliliters or greater on CT imaging (+1 point). Use the ABC/2 calculator below if needed.
Blood present within the ventricular system on CT imaging (+1 point)
Hemorrhage origin in the brainstem or cerebellum (posterior fossa) (+1 point)
Calculate ICH Score
Select the GCS range and answer all four clinical variables above to calculate the ICH Score. Results and visualizations will appear instantly.
How to Use the ICH Calculator
Select the GCS Range
Choose the Glasgow Coma Scale range that matches the patient's presentation: GCS 13–15 (0 points), GCS 5–12 (1 point), or GCS 3–4 (2 points). If you do not know the total GCS, expand the GCS Sub-Score Calculator to select eye opening, verbal response, and motor response components individually — the total will be calculated and mapped to the correct band automatically.
Answer the Four Clinical Variables
For each of the four remaining variables — age 80 years or older, ICH volume 30 mL or greater, intraventricular hemorrhage present, and infratentorial origin — select Yes or No based on the patient's demographics and CT imaging findings. If you need to estimate hematoma volume, expand the ABC/2 Volume Calculator to enter CT dimensions directly.
Review the ICH Score and Mortality Risk
Once all five variables are answered, the total ICH Score (0–6) and corresponding 30-day mortality percentage are displayed immediately along with a color-coded risk level, score spectrum visualization, mortality bar, and detailed per-parameter breakdown. Review the mortality reference table to see how the patient's score compares across all possible scores.
Explore Clinical Context and Export Results
Expand the Clinical Next Steps section for evidence-based management recommendations. Review the ICH vs FUNC Score comparison for additional prognostic context. Use the Export CSV button to download results for documentation, or the Print button to generate a print-friendly summary for the patient chart or clinical discussion.
Frequently Asked Questions
What is the ICH Score and who developed it?
The ICH Score is a validated clinical grading scale designed to predict 30-day mortality in patients with spontaneous intracerebral hemorrhage. It was developed by Dr. J. Claude Hemphill III and colleagues at the University of California, San Francisco, and published in the journal Stroke in 2001. The score was derived from a retrospective analysis of 161 consecutive patients with spontaneous ICH admitted to UCSF between 1997 and 1998. Through multivariate logistic regression, the researchers identified five independent predictors of mortality: GCS score, patient age, hematoma volume, presence of intraventricular hemorrhage, and infratentorial origin. The resulting 0-to-6 scale has since been externally validated in multiple studies worldwide.
How is the ICH Score calculated?
The ICH Score is the sum of five components: the Glasgow Coma Scale at presentation (GCS 3–4 receives 2 points, GCS 5–12 receives 1 point, and GCS 13–15 receives 0 points), patient age 80 years or older (1 point if yes, 0 if no), ICH volume 30 milliliters or greater on CT imaging (1 point if yes, 0 if no), the presence of intraventricular hemorrhage on CT (1 point if yes, 0 if no), and infratentorial hemorrhage origin (1 point if yes, 0 if no). The total score ranges from 0 to 6. Higher scores indicate worse prognosis, with 30-day mortality rates of 0%, 13%, 26%, 72%, 97%, and 100% for scores 0 through 5 respectively.
What is the ABC/2 formula for estimating hematoma volume?
The ABC/2 formula, also known as the Kothari method, is a widely used bedside technique for estimating intracerebral hematoma volume from axial CT images. A represents the largest diameter of the hemorrhage on the CT slice showing the greatest extent of bleeding, measured in centimeters. B is the diameter perpendicular to A on the same slice. C represents the craniocaudal extent, calculated as the number of CT slices containing visible hemorrhage multiplied by the slice thickness. The volume in milliliters equals (A times B times C) divided by 2. This formula approximates the hematoma as an ellipsoid. For the ICH Score, volumes of 30 mL or greater receive 1 point.
Can the ICH Score be used to decide whether to withdraw treatment?
No. Dr. Hemphill, the score's creator, has explicitly cautioned against using the ICH Score as the sole basis for limiting or withdrawing aggressive treatment. Research has demonstrated that early do-not-resuscitate orders placed primarily based on high ICH scores can create a self-fulfilling prophecy, where patients who might have survived with aggressive management are denied that opportunity. The ICH Score is intended as a clinical grading and communication tool to help healthcare teams discuss severity and prognosis. Goals-of-care decisions must incorporate the patient's expressed wishes, premorbid functional status, comorbidities, and the complete clinical picture — not a numerical score alone.
What is the difference between the ICH Score and the FUNC Score?
The ICH Score and the FUNC Score are complementary but distinct prognostic tools for intracerebral hemorrhage. The ICH Score (range 0–6) predicts 30-day mortality, with higher scores indicating worse prognosis. The FUNC Score (range 0–11) predicts the likelihood of achieving functional independence at 90 days, with higher scores indicating better expected functional outcome. The FUNC Score incorporates some of the same variables as the ICH Score — including GCS, age, volume, and location — but weights them differently and adds consideration of pre-ICH cognitive impairment. Using both scores together provides a more complete prognostic picture covering both survival and functional recovery.
When should the ICH Score be assessed and does it apply to all types of brain hemorrhage?
The ICH Score should be calculated at the time of initial hospital admission and reassessed at 24 hours post-admission to identify trends in clinical status. It applies specifically to spontaneous (non-traumatic) intracerebral hemorrhage — bleeding caused by hypertensive vasculopathy, cerebral amyloid angiopathy, coagulopathy, or other non-traumatic etiologies. The ICH Score was not validated for traumatic intracerebral hemorrhage, epidural hematoma, subdural hematoma, or subarachnoid hemorrhage. It is also important to note that the original validation cohort was relatively small (161 patients from a single center), and mortality estimates may differ in contemporary practice due to advances in neurocritical care, blood pressure management, and surgical techniques.