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Modeling the Predictive Performance of the ICH Score: Stepwise Selection and Logistic Modeling of Mortality,

Hussain Alkhars1, Sean M Lee2, Brij Kathuria1

  • 1Department of Neurological Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.

Neurosurgery Practice
|February 9, 2026
PubMed

Insights

The intracerebral hemorrhage (ICH) score accurately predicts mortality but has limited accuracy for predicting patient functional outcomes, length of stay, and discharge placement. Further research is needed to improve its prognostic capabilities.

Area of Science:

  • Neurology
  • Clinical Prognostication
  • Health Services Research

Background:

  • The intracerebral hemorrhage (ICH) score is a common tool for predicting mortality in patients with ICH.
  • Its effectiveness in predicting functional outcomes, length of stay (LOS), and discharge placement is not well-established.

Purpose of the Study:

  • To evaluate the predictive performance of the ICH score for various clinical outcomes in ICH patients.
  • To assess the score's accuracy in predicting mortality, functional status, LOS, and discharge disposition.

Main Methods:

  • A retrospective study of 273 ICH patients (2018-2023).
  • Logistic regression models were used to assess the ICH score's predictive performance for in-hospital mortality, modified Rankin Scale (mRS) at discharge, LOS (ICU and hospital), and discharge placement.
  • Leave-one-out cross-validation and stepwise selection were employed for performance assessment and identifying significant components.

Main Results:

  • The ICH score accurately predicted in-hospital mortality (accuracy: 0.89).
  • It demonstrated moderate performance for predicting discharge mRS (accuracy: 0.67), particularly for mortality, but was less reliable for functional independence or severe disability.
  • The score poorly predicted ICU and hospital LOS and was unable to differentiate intermediate discharge placements.

Conclusions:

  • The ICH score is reliable for predicting in-hospital mortality in ICH patients.
  • Its predictive accuracy for functional outcomes, length of stay, and discharge placement is limited.
  • The ICH score is valuable for risk stratification but has restricted utility for individualized prognostication; incorporating additional factors may enhance prediction.
Abstract

Keywords:
Discharge placementICH scoreIntracerebral hemorrhageLength of stayModified Rankin scaleMortalityPrognostication

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