Mortality prediction reflects Hemphill et al. (2001) validation.
Clinical Intelligence
Select patient metrics to execute high-fidelity mortality prediction based on the Original Hemphill ICH Score.
Ready For Calculation
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Predicting 30-day mortality in patients with spontaneous intracerebral haemorrhage.
Initial communication with family regarding prognosis.
Standardizing clinical research and internal audit in stroke/neurosurgical units.
Section 2
Formula & Logic
Scoring Components
Factor
0 Points
1 Point
2 Points
GCS Score
13–15
5–12
3–4
Age
< 80
≥ 80
-
Infratentorial
No
Yes
-
ICH Volume
< 30 cm³
≥ 30 cm³
-
IVH
No
Yes
-
Section 3
Pearls/Pitfalls
The "Spot Sign"
While the ICH Score predicts mortality, it does not account for ACTIVE expansion. If performing a CTA, look for the "Spot Sign" (contrast extravasation), which predicts haematoma growth and may override the baseline ICH score in urgency.
Avoid Self-Fulfilling Prophecy
Critically, many poor outcomes at high ICH scores (e.g., 4 or 5) are due to withdrawal of care. The AHA/ASA guidelines recommend aggressive full care for at least the first 24 hours regardless of score to avoid a "self-fulfilling prophecy" of mortality.
Section 4
Evidence Appraisal
Primary Reference
The ICH score: a simple, reliable grading scale for intracerebral hemorrhage
