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Prospective validation of the ICH Score for 12-month functional outcome

From the Department of Neurology (J.C.H., M.F.), Brain and Spinal Injury Center (J.C.H.), University of California, San Francisco; and Sacred Heart Hospital (T.A.N.), Pensacola, FL.

Address correspondence and reprint requests to Dr. J. Claude Hemphill III, Neurocritical Care Program, Department of Neurology, Room 4M62, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110 chemphill{at}sfgh.ucsf.edu

Background: The ICH Score is a commonly used clinical grading scale for outcome after acute intracerebral hemorrhage (ICH) and has been validated for 30-day mortality, but not long-term functional outcome. The goals of this study were to assess whether the ICH Score accurately stratifies patients with regard to 12-month functional outcome and to further delineate the pace of recovery of patients during the first year post-ICH.

Methods: We performed a prospective observational cohort study of all patients with acute ICH admitted to the emergency departments of San Francisco General Hospital and UCSF Medical Center from June 1, 2001, through May 31, 2004. Components of the ICH Score (admission Glasgow Coma Scale score, initial hematoma volume, presence of intraventricular hemorrhage, infratentorial ICH origin, and age) were recorded along with other clinical characteristics. Patients were then assessed with the modified Rankin Scale (mRS) at hospital discharge, 30 days, and 3, 6, and 12 months post-ICH.

Results: Of 243 patients, 95 (39%) died during initial acute hospitalization. The ICH Score accurately stratified patients with regard to 12-month functional outcome for various dichotomous cutpoints along the mRS (p < 0.05). Many patients continued to improve across the first year, with a small number of patients becoming disabled or dying due to late events unrelated to the initial ICH.

Conclusions: The ICH Score is a valid clinical grading scale for long-term functional outcome after acute intracerebral hemorrhage (ICH). Many ICH patients improve after hospital discharge and this improvement may continue even after 6 months post-ICH.

Abbreviations: CHR = Committee on Human Research; ED = emergency department; GCS = Glasgow Coma Scale; ICH = intracerebral hemorrhage; IVH = intraventricular hemorrhage; mRS = modified Rankin Scale; SFGH = San Francisco General Hospital.

Editorial, page 1084

e-Pub ahead of print on September 2, 2009, at www.neurology.org.

Supported by grant K23 NS41240 from NIH/NINDS.

Disclosure: Author disclosures are provided at the end of the article.

Received December 24, 2008. Accepted in final form June 17, 2009.

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