This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Grading a brain hemorrhage
Spontaneous intracerebral hemorrhage (ICH), bleeding inside the brain tissue, causes 10 to 15% of strokes and has a high early mortality. The ICH score, published by Hemphill and colleagues in 2001, grades its severity from five items that are available on arrival: the level of consciousness, the size of the bleed, its spread into the ventricles, its location and the patient’s age.
The five items
| Item | Points |
|---|---|
| Glasgow Coma Scale 3–4 | 2 |
| Glasgow Coma Scale 5–12 | 1 |
| Glasgow Coma Scale 13–15 | 0 |
| Hematoma volume ≥ 30 mL | 1 |
| Intraventricular hemorrhage | 1 |
| Infratentorial origin (brainstem or cerebellum) | 1 |
| Age ≥ 80 years | 1 |
The total ranges from 0 to 6.
Estimating the volume with ABC/2
The calculator can estimate the hematoma volume from the CT scan with the ABC/2 method: A is the largest diameter of the bleed on the slice where it is largest, B the largest diameter perpendicular to A on the same slice, and C the vertical extent, the number of slices with blood times the slice thickness. With lengths in centimeters, volume ≈ A × B × C ÷ 2 in mL. The method assumes a roughly ellipsoid bleed and overestimates irregular ones.
Example
A 68-year-old patient with a Glasgow score of 11, a supratentorial bleed measuring 4 × 4 × 3 cm and blood in the ventricles:
- Volume: 4 × 4 × 3 ÷ 2 = 24 mL, so 0 points
- Glasgow 11: 1 point; intraventricular blood: 1 point; age under 80: 0
- ICH score: 2, with a 30-day mortality of about 26% in the original cohort
Mortality by score
In the derivation cohort, 30-day mortality was 0% for a score of 0, 13% for 1, 26% for 2, 72% for 3, 97% for 4 and 100% for 5. Later studies confirmed the gradient, with lower mortality in centers with aggressive care.
Use with care
The ICH score is a communication and research tool. American Heart Association guidelines advise against using it alone to decide to limit treatment, because early do-not-resuscitate orders make poor outcomes more likely and the prediction self-fulfilling.