Related Experiment Video
Updated: Mar 7, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Prognosticating Functional Outcome After Intracerebral Hemorrhage: The ICHOP Score
Vivek P Gupta1, Andrew L A Garton1, Jonathan A Sisti1
1College of Physicians and Surgeons, Columbia University, New York, USA.
Insights
New scoring systems, ICHOP3 and ICH12, improve prediction of functional outcomes after intracerebral hemorrhage (ICH) by including systemic factors and premorbid status. These scores offer a more comprehensive prognosis than the original ICH Score.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Intracerebral hemorrhage (ICH) carries high morbidity and mortality.
- Existing scoring systems like the ICH Score have limitations.
- Systemic factors and premorbid functional status are not adequately incorporated into current ICH prognostication.
Purpose of the Study:
- To develop novel scoring systems for predicting 3-month and 12-month functional outcomes after ICH.
- To incorporate systemic physiologic factors and premorbid functional status into ICH prognostication.
- To compare the performance of the new scoring systems against the established ICH Score.
Main Methods:
- Utilized Random Forest machine learning to identify key prognostic factors from a large dataset (>200 data points/patient).
- Employed linear regression to build initial models, followed by weight modification for improved accuracy.
- Developed two distinct scores: ICHOP3 (3-month) and ICH12 (12-month).
Main Results:
- ICHOP3 and ICHOP12 scores incorporate Glasgow Coma Scale, NIH Stroke Scale, APACHE II, premorbid mRS, and hematoma volume (ICHOP3 only).
- Achieved high discriminatory power with Areas Under the Curve of 0.89 (3-month) and 0.87 (12-month) for predicting functional outcomes (mRS 0-3 vs. 4-6).
- Both ICHOP scores demonstrated significantly superior prognostic accuracy compared to the original ICH Score.
Conclusions:
- The novel ICHOP scores provide a more comprehensive assessment of long-term functional prognosis after ICH.
- Incorporation of systemic physiologic factors and premorbid functional status enhances prognostic accuracy.
- ICHOP scores represent a significant advancement in predicting patient outcomes following intracerebral hemorrhage.
Background:
The morbidity, mortality, and monetary cost associated with intracerebral hemorrhage (ICH) is devastatingly high. Several scoring systems have been proposed to prognosticate outcomes after ICH, although the original ICH Score is still the most widely used. However, recent research suggests that systemic physiologic factors, such as those included in the Acute Physiology and Chronic Health Evaluation II score, may also influence outcome. In addition, no scoring systems to date have included premorbid functional status. Therefore, we propose a scoring system that incorporates these factors to prognosticate 3-month and 12-month functional outcomes.
Methods:
We used the Random Forest machine-learning technique to identify factors from a dataset of more than 200 data points per patient that were most strongly affiliated with functional outcome. We then used linear regression to create an initial model based on these factors and modified weightings to improve accuracy. Our scoring system was compared with the ICH Score for prognosticating functional outcomes.
Results:
Two separate scoring systems (Intracerebral Hemorrhage Outcomes Project 3 [ICHOP3] and ICHOP12) were developed for 3-month and 12-month functional outcomes using Glasgow Coma Scale, National Institutes of Health Stroke Scale, Acute Physiology and Chronic Health Evaluation II, premorbid modified Rankin Scale (mRS), and hematoma volume (3-month only). Patient outcomes were dichotomized into good (mRS score, 0-3) and poor (mRS score, 4-6) categories based on functional status. Areas under the curve in the derivation cohort for predicting mRS score were 0.89 (3-month) and 0.87 (12-month); both were significantly more discriminatory than the original ICH Score.
Conclusions:
The ICHOP scores may provide more comprehensive evaluation of a patient's long-term functional prognosis by taking into account systemic physiologic factors as well as premorbid functional status.
