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Updated: Feb 10, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
The Intracerebral Hemorrhage Score: A Self-Fulfilling Prophecy?
D Jay McCracken1, Brendan P Lovasik2, Courtney E McCracken2
1Department of Neurosurgery, Emory University, Atlanta, Georgia.
Insights
The Intracerebral Hemorrhage (ICH) Score may overestimate mortality in current patients. Survival rates exceeded predictions, suggesting a need to reevaluate this standard risk-stratification tool for better prognoses.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- The Intracerebral Hemorrhage (ICH) Score is the standard for predicting 30-day mortality in patients with spontaneous ICH.
- Treatment protocols for ICH have evolved significantly since the ICH Score's inception 17 years ago.
Purpose of the Study:
- To assess the continued accuracy of the ICH Score in predicting 30-day mortality in contemporary ICH patient cohorts.
- To evaluate the role of the ICH Score in current patient management and outcomes.
Main Methods:
- Retrospective review of 554 patients with acute, spontaneous ICH treated between 2010 and 2014 at two academic institutions.
- Analysis included patients managed medically and those receiving surgical interventions like external ventricular drains or craniotomy.
- Data collected included ICH Score, Glasgow Coma Scale, and hemorrhage volumes.
Main Results:
- Overall mortality was 25.1%.
- Observed mortality for moderate ICH Scores (3 and 4) was significantly lower than predicted by the original ICH Score (49% vs. 72% and 71% vs. 97%, respectively; P < .001).
- Patient survival exceeded ICH Score-predicted mortality, irrespective of surgical intervention.
Conclusions:
- The original ICH Score did not accurately predict mortality in this contemporary cohort.
- Current treatment strategies may contribute to improved survival beyond the score's predictions.
- Reevaluation of predictive scoring systems for ICH is warranted to enhance prognostic accuracy.
Background:
The ICH Score has become the standard for risk-stratification of 30-d mortality in patients with intracerebral hemorrhage (ICH), but treatment has evolved over the last 17 yr since its inception. We sought to determine if the ICH Score remains an accurate predictor of 30-d mortality in these high acuity patients.
Objective:
To determine the role the ICH Score has on mortality in current treatment of patients.
Methods:
A retrospective review of 554 patients treated for acute, spontaneous ICH at 2 large academic institutions between 2010 and 2014 was carried out. Surgical intervention in the form of external ventricular drain or craniotomy was performed when indicated. All patients were managed medically until discharge or death.
Results:
Over half (53.6%) of the patients presented with ICH of the basal ganglia/thalamus and the majority (71%) presented with ICH Scores of 0 to 2. Overall mortality was 25.1%. Observed mortality in moderate grade ICH Score patients (3 and 4) was lower than expected (49% vs 72%, P < .001) and (71% vs 97%, P < .001) when compared to the original ICH Score results. Despite differences in ICH and intraventricular hemorrhage volume, and Glasgow Coma Scale there was no difference in surgical intervention (12.2% vs 11.8%, P = .94) between the two groups. Withdrawal of care was instituted in 56.6% of all patients who died and increased with ICH Score.
Conclusion:
In our cohort, the original ICH score did not accurately predict the mortality rate. Patient survival exceeded ICH Score-predicted mortality regardless of surgical intervention. Reevaluation of predictive scores could be useful to aid in more accurate prognoses.
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