ICH Calculator - Free Online Tool

Predict 30-day mortality risk in spontaneous intracerebral hemorrhage using the validated Hemphill ICH Score (0–6)

The Intracerebral Hemorrhage (ICH) Score is a validated clinical grading scale developed to predict 30-day mortality in patients presenting with spontaneous intracerebral hemorrhage. Published in 2001 by Dr. J. Claude Hemphill III and colleagues at the University of California, San Francisco (UCSF), the ICH Score has become one of the most widely used bedside prognostic tools in neurocritical care. Its simplicity, reliability, and strong correlation with clinical outcomes have made it a standard component of the initial assessment for patients with spontaneous ICH in emergency departments and intensive care units around the world. Intracerebral hemorrhage — bleeding directly into the brain parenchyma — accounts for approximately 10 to 15 percent of all strokes and carries the highest mortality rate of any stroke subtype. Unlike ischemic stroke, where reperfusion therapies have dramatically improved outcomes, the management of ICH remains primarily supportive, focusing on blood pressure control, reversal of anticoagulation, prevention of hematoma expansion, and management of elevated intracranial pressure. The ICH Score provides a standardized framework for clinicians to quickly assess severity at presentation and communicate risk among the care team. The original ICH Score was derived from a retrospective analysis of 161 consecutive patients admitted to UCSF Medical Center between 1997 and 1998 with spontaneous ICH confirmed on computed tomography. Through multivariate logistic regression analysis, Hemphill and colleagues identified five independent predictors of 30-day mortality: the Glasgow Coma Scale (GCS) score at presentation, patient age 80 years or older, ICH volume 30 milliliters or greater, the presence of intraventricular hemorrhage (IVH), and infratentorial hemorrhage origin. Each variable was assigned a point value based on its relative contribution to mortality risk, producing a total score ranging from 0 to 6. The Glasgow Coma Scale component is the most heavily weighted variable in the ICH Score, reflecting the fundamental importance of the level of consciousness in predicting neurological outcome. A GCS of 3 to 4, indicating deep coma, receives 2 points. A GCS of 5 to 12, representing moderate to severe impairment, receives 1 point. A GCS of 13 to 15, indicating relatively preserved consciousness, receives 0 points. This three-tier stratification captures the well-established clinical observation that patients who are comatose at presentation have significantly worse outcomes than those who are alert or mildly impaired. Patient age is the second demographic variable in the score. Patients aged 80 years or older receive 1 point, reflecting the reduced physiologic reserve and diminished capacity for neurological recovery in elderly patients. This threshold was validated in the original study and has been confirmed in subsequent external validation cohorts. Hematoma volume is assessed as a binary variable using the threshold of 30 milliliters. Volumes at or above this threshold receive 1 point. The most commonly used method for estimating hematoma volume from CT imaging is the ABC/2 formula, also known as the Kothari method. In this formula, A represents the largest diameter of the hemorrhage on the CT slice showing the greatest extent of bleeding, B represents the diameter perpendicular to A on the same slice, and C represents the craniocaudal extent calculated as the number of CT slices showing hemorrhage multiplied by the slice thickness. The product of these three dimensions divided by 2 provides an approximation of the ellipsoid volume in milliliters. This calculator includes a built-in ABC/2 volume estimator that automatically determines whether the volume meets or exceeds the 30 mL threshold. The presence of intraventricular hemorrhage — blood extending into the ventricular system of the brain — adds 1 point to the ICH Score. IVH is associated with obstruction of cerebrospinal fluid pathways, development of hydrocephalus, and direct neuronal injury from blood products within the ventricles. Its presence is a well-established independent predictor of poor outcome in patients with ICH. The fifth and final variable is hemorrhage location. Infratentorial hemorrhages, originating in the brainstem or cerebellum, receive 1 point compared to supratentorial hemorrhages that receive 0 points. Infratentorial hemorrhages carry higher mortality because of their proximity to vital brainstem structures controlling consciousness, respiration, and cardiovascular regulation. Even relatively small hematomas in the posterior fossa can cause rapid deterioration through brainstem compression or obstructive hydrocephalus. The ICH Score maps directly to 30-day mortality rates from the original validation study: a score of 0 corresponds to 0 percent mortality, a score of 1 to 13 percent, a score of 2 to 26 percent, a score of 3 to 72 percent, a score of 4 to 97 percent, and scores of 5 and 6 to 100 percent. It is important to note that no patients in the original study cohort achieved a score of 6, so the 100 percent mortality figure for that score is an extrapolation rather than an observed value. Dr. Hemphill himself has emphasized a crucial caveat about the use of the ICH Score: it is designed as a clinical grading and communication tool, not as a basis for limiting or withdrawing aggressive treatment. Research has shown that early do-not-resuscitate orders placed based primarily on high ICH scores can create a self-fulfilling prophecy in which patients who might have survived with aggressive treatment are denied the opportunity for recovery. The ICH Score should inform but never dictate goals-of-care decisions, which must incorporate the patient's expressed wishes, premorbid functional status, and the full clinical context. This calculator provides a comprehensive implementation of the ICH Score with several enhancements beyond basic score calculation. The built-in GCS sub-score calculator allows users who do not know the total GCS to derive it from eye opening, verbal response, and motor response components, which are then automatically mapped to the appropriate ICH score band. The integrated ABC/2 volume estimator allows direct entry of hematoma dimensions from CT imaging. Visual charts display the score on a 0-to-6 spectrum with color-coded risk levels and a mortality risk bar. A detailed breakdown shows the point contribution of each parameter, and a comparison table contrasts the ICH Score with the FUNC Score, which predicts functional independence at 90 days rather than mortality. Together, these features make this tool a comprehensive educational and clinical reference resource for healthcare professionals assessing patients with spontaneous intracerebral hemorrhage.

Understanding the ICH Score

The ICH Score is a validated clinical grading scale that assigns points based on five independent predictors of 30-day mortality in spontaneous intracerebral hemorrhage. The total score ranges from 0 to 6 and directly correlates with increasing mortality risk.

How the ICH Score Was Developed

The ICH Score was developed by Dr. J. Claude Hemphill III and colleagues at UCSF from a retrospective analysis of 161 consecutive patients with spontaneous ICH admitted between 1997 and 1998. Using multivariate logistic regression, they identified five clinical and radiographic variables that independently predicted 30-day mortality. Each variable was assigned a point value proportional to its contribution to mortality risk. The resulting 0-to-6 scale was validated against observed mortality rates in the study cohort, demonstrating a strong and monotonic relationship between score and outcome.

The Five Scoring Components

The ICH Score incorporates five variables: the Glasgow Coma Scale (GCS) score at presentation (0, 1, or 2 points), patient age 80 years or older (0 or 1 point), ICH volume 30 mL or greater (0 or 1 point), presence of intraventricular hemorrhage (0 or 1 point), and infratentorial hemorrhage origin (0 or 1 point). The GCS component is the most heavily weighted, reflecting the critical importance of the level of consciousness. The remaining four variables are each binary yes/no assessments contributing 0 or 1 point each.

ABC/2 Volume Estimation and GCS Calculation

Two of the five ICH Score variables — hematoma volume and GCS — can be challenging to determine at the bedside. The ABC/2 formula (Kothari method) allows clinicians to estimate hematoma volume from axial CT images by measuring the largest hemorrhage diameter (A), the perpendicular diameter (B), and the craniocaudal extent (C), then dividing the product by 2. Similarly, the GCS total is derived from three sub-scores: eye opening (1–4), verbal response (1–5), and motor response (1–6). This calculator includes built-in helpers for both calculations to streamline the assessment process.

Clinical Limitations and Proper Use

The ICH Score is a population-level statistical tool derived from a single-center 1997–1998 cohort. Its mortality estimates may not generalize perfectly to all patient populations, especially with advances in neurocritical care since 2001. No patients in the original study achieved a score of 6, so that mortality estimate is extrapolated. Critically, the score's creator has warned against using it to justify withdrawal of aggressive treatment, as early limitation of care based solely on the ICH Score can become a self-fulfilling prophecy. The score should be used as one element of a comprehensive clinical assessment, not as a sole determinant of prognosis.

ICH Score Formulas

ICH Score

ICH Score = GCS_pts + Age_pts + Volume_pts + IVH_pts + Location_pts

Sum of five components scored 0–6. GCS contributes 0–2 points; the other four variables each contribute 0 or 1 point. Higher scores indicate worse prognosis.

ABC/2 Volume Estimation

Volume (mL) = (A × B × C) / 2

Kothari method for estimating hematoma volume from CT imaging. A = largest diameter, B = perpendicular diameter, C = craniocaudal extent (slices × thickness). All in centimeters.

Glasgow Coma Scale (GCS)

GCS = E + V + M

Sum of Eye opening (1–4), Verbal response (1–5), and Motor response (1–6). Total range 3–15. Mapped to ICH points: GCS 13–15 = 0 pts, GCS 5–12 = 1 pt, GCS 3–4 = 2 pts.

30-Day Mortality Mapping

Mortality(%) = f(ICH Score)

Empirical mapping from the original Hemphill 2001 study: Score 0 → 0%, Score 1 → 13%, Score 2 → 26%, Score 3 → 72%, Score 4 → 97%, Score 5–6 → 100%.

ICH Reference Tables

ICH Score Components and Point Values

Each of the five ICH Score variables with their scoring criteria and point assignments from the Hemphill 2001 validation study.

Component	Criteria	Points
GCS 13–15	Alert to mildly impaired	0
GCS 5–12	Moderate to severe impairment	1
GCS 3–4	Deep coma	2
Age ≥ 80 years	Patient is 80 years or older	1
Age < 80 years	Patient is younger than 80	0
ICH Volume ≥ 30 mL	Hematoma ≥ 30 mL on CT	1
ICH Volume < 30 mL	Hematoma < 30 mL on CT	0
IVH Present	Blood in ventricular system	1
IVH Absent	No intraventricular blood	0
Infratentorial	Brainstem or cerebellum origin	1
Supratentorial	Cerebral hemisphere origin	0

30-Day Mortality by ICH Score

Observed 30-day mortality rates from the original Hemphill et al. UCSF validation cohort (N=161, Stroke 2001).

ICH Score	30-Day Mortality	Risk Level
0	0%	Minimal
1	13%	Low
2	26%	Moderate
3	72%	High
4	97%	Very High
5	100%	Critical
6*	100%*	Critical (*extrapolated, not observed in original study)

Worked Examples

Elderly patient with deep hemorrhage and IVH

A 72-year-old male presents with sudden onset headache and left-sided weakness. GCS is 10. CT shows a 40 mL right basal ganglia (deep supratentorial) hemorrhage with extension into the lateral ventricles.

GCS component: GCS 10 falls in the 5–12 range → 1 point

Age component: 72 years is < 80 → 0 points

Volume component: 40 mL ≥ 30 mL threshold → 1 point

IVH component: Intraventricular extension present → 1 point

Location component: Deep supratentorial (not infratentorial) → 0 points

Total: 1 + 0 + 1 + 1 + 0 = 3

ICH Score = 3, corresponding to 72% 30-day mortality (High Risk). Aggressive neurocritical care, BP management, and goals-of-care discussion are warranted.

Young patient with cerebellar hemorrhage

A 55-year-old female presents with acute vertigo, vomiting, and ataxia. GCS is 14. CT reveals a 22 mL cerebellar hemorrhage without intraventricular extension.

GCS component: GCS 14 falls in the 13–15 range → 0 points

Age component: 55 years is < 80 → 0 points

Volume component: 22 mL < 30 mL threshold → 0 points

IVH component: No intraventricular hemorrhage → 0 points

Location component: Cerebellar = infratentorial origin → 1 point

Total: 0 + 0 + 0 + 0 + 1 = 1

ICH Score = 1, corresponding to 13% 30-day mortality (Low Risk). Despite the low score, cerebellar hemorrhages require close monitoring for brainstem compression and obstructive hydrocephalus.

Using ABC/2 to determine volume threshold

CT imaging shows a hemorrhage with A = 5.2 cm (largest diameter), B = 3.8 cm (perpendicular), and C = 4.0 cm (craniocaudal extent from 8 slices × 0.5 cm thickness).

Apply the ABC/2 formula: Volume = (5.2 × 3.8 × 4.0) / 2

Calculate: 5.2 × 3.8 = 19.76; 19.76 × 4.0 = 79.04

Volume = 79.04 / 2 = 39.5 mL

39.5 mL ≥ 30 mL → Volume component = 1 point

Estimated hematoma volume is 39.5 mL, exceeding the 30 mL threshold. This contributes 1 point to the ICH Score volume component.

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.