Predicting Outcome for Intracerebral Hemorrhage Patients: Current Tools and Their Limitations

Accurate outcome prognostication is critical to the management of patients with primary or spontaneous intracerebral hemorrhage (ICH). Prognostication may guide the decision to pursue aggressive acute management or to plan proper goals of care for patients who will likely suffer long-term severe disability. In particular, early predictions of poor outcome for ICH patients routinely influence discussions with surrogate decision makers to pursue do-not-resuscitate orders or comfort care, practices that may often be appropriate, but that are at risk for self-fulfilling prophecies. The authors review the literature pertaining to these concepts. Currently available baseline severity scores, with a focus on the ICH Score, are summarized and compared, with a discussion of the limitations and biases of such clinical scales derived from observational cohorts. New research on the accuracy of the subjective early clinical judgment of physicians and nurses for predicting ICH functional outcome as it compares to that of baseline severity scores, is also summarized.