Nandakumar Nagaraja, MD

Parry-Jones AR, Abid KA , Di Napoli M, Smith CJ, Vail A, Patel HC, et al. Accuracy and Clinical Usefulness of Intracerebral Hemorrhage Grading ScoresA Direct Comparison in a UK Population. Stroke. 2013

Intracerebral hemorrhage is a devastating condition associated with high early mortality rate. Physicians managing patients with ICH constantly face challenging management decisions including the choice between aggressive care versus withdrawal of care. Intracerebral hemorrhage grading scores (such as the original ICH score (oICH), modified ICH score (mICH) and ICH Grading Scale (ICH GS)) are used in clinical practice to predict mortality after ICH and guide management.

Parry-Jones and colleagues evaluated the accuracy and clinical usefulness of the ICH grading scores and GCS to predict outcome in their cohort of 1364 patients. The authors found that all 3 grading scores – oICH, mICH and ICH GS for ICH are highly predictive for 30 day mortality. One of the interesting findings of the study was that GCS alone was as good as three ICH scores in predicting 30 day mortality, thus eliminating the need for measuring hematoma volume. Age was a poor predictor of 30 day mortality.

A study published in Neurology in 2007 by Zahuranec et al., showed that early limitation of care was independently associated with short and long term mortality after ICH. Therefore, it is probably reasonable to have an aggressive medical approach to manage these patients acutely and use the ICH grading scores or GCS to guide in further management after the acute phase.