ICH Calculator - 0-6 Hemphill Score, 30-Day Mortality

The ICH calculator is a bedside grading scale for spontaneous intracerebral hemorrhage that turns five admission factors into a 0 to 6 severity total and a published 30-day mortality band on a single form, ready for an ED team to fill in alongside the admission CT.

• • Emergency department triage: Enter the admission GCS, age, hematoma volume, IVH status, and infratentorial origin and read the 0 to 6 total on the same screen as the CT report.
• • Neurocritical care handoff: Use the total as a one-line summary of admission severity when handing a patient from the emergency team to the neuro ICU.
• • Family discussion aid: Pair the 30-day band with the goals of care so families hear the same numbers the stroke team is reading from the chart.
• • Quality and research review: Apply the published 2001 Hemphill table to retrospective case review or stroke registry work without re-deriving the lookup by hand.

The 2001 Hemphill paper remains the most widely cited bedside grading scale for spontaneous intracerebral hemorrhage, and this form follows that rule.

Triage, palliative care, and discharge decisions sit with the stroke team and should consider the total alongside the goals of care and admission CT.

For a fuller ICU admission review that also includes chronic health and 12 physiologic variables, the Apache II Calculator sits next to the ICH calculator on the same clinical handoff.

The form works in three steps: it scores each of the five admission factors on a published band, sums the five contributions, and looks up the 30-day band in the 2001 Hemphill table.

• Glasgow Coma Scale: Admission GCS total from 3 (deep coma) to 15 (fully alert). Adds 2 points for 3-5, 1 point for 6-12, and 0 points for 13-15.
• Age: Patient age in completed years. Adds 1 point at age 80 or older and 0 points below 80.
• ICH volume: Admission CT hematoma volume in mL, typically the ABC/2 method. Adds 1 point at 30 mL or above.
• Intraventricular hemorrhage: Presence of blood in the ventricular system on the admission CT. Adds 1 point when present.
• Infratentorial origin: Whether the bleed originated in the brainstem or cerebellum. Adds 1 point when infratentorial.

The total is the sum of the five band scores. The GCS band carries the most weight per point because the 3 to 5 range alone adds 2 points.

Inputs are clamped to the published clinical range (GCS 3-15, age 0-120, hematoma 0-200 mL) so the form returns the same band whether the team types 79 or 81 for age and 29 or 31 for hematoma.

According to Hemphill et al., Stroke 2001, the ICH score uses five clinical factors (GCS band, age band, ICH volume band, intraventricular hemorrhage, infratentorial origin) and the 30-day mortality table ranging from 0% at score 0 to 100% at scores 5 and 6.

Blood pressure control is the next step after grading, and the Blood Pressure Calculator turns a single cuff reading into systolic, diastolic, and mean arterial pressure used to titrate antihypertensive therapy in the first hours of ICH care.

Four concepts drive the result. Naming them keeps the total from being read as a single lab number, which it is not.

The five factors are not weighted equally. The GCS band contributes 0 to 2 points while every other factor contributes 0 or 1 point, so consciousness is the largest driver of the total.

Functional outcome follows the ICH calculator total on the same chart, and the Barthel Index totals the ten ADL and mobility items from the 1965 Mahoney and Barthel scale for a 0 to 100 independence band used to track ICH survivors through rehab and discharge planning.

The form works from a small set of admission measurements. Each input should be set to the admission value before the ICH calculator returns the total and 30-day band.

1. 1 Enter the Glasgow Coma Scale: Type the admission GCS total from 3 to 15. The form maps it to the 3-5, 6-12, and 13-15 bands automatically.
2. 2 Enter the patient age: Type the age in completed years. The form adds 1 point at age 80 or older.
3. 3 Enter the ICH volume and IVH status: Type the admission CT hematoma volume in mL and pick whether the bleed extended into the ventricles.
4. 4 Pick the infratentorial origin flag: Pick yes if the bleed originated in the brainstem or cerebellum, and no otherwise. The form adds 1 point for a yes answer.
5. 5 Read the ICH total and mortality band: The form returns the 0 to 6 total, the per-factor point breakdown, and the 30-day band from the 2001 Hemphill table.

A reader with GCS 12, age 82, ICH volume 24 mL, IVH yes, and supratentorial origin enters those values and reads a total of 3 with a 72% band.

For a parallel acute-care scoring example that also follows a published bedside scale, the Alvarado Calculator totals the eight appendicitis items into a 0 to 10 band on the same single-form pattern.

Calculating the ICH total from a small set of admission measurements has practical benefits over running the 2001 scoring table by hand at the bedside.

• • Five factors, one form: A single form turns the admission GCS, age, hematoma volume, IVH, and infratentorial origin into a 0 to 6 total.
• • Per-factor point breakdown: The result panel returns the GCS, age, volume, IVH, and infratentorial points so the next reader of the chart can see which factor drove the total.
• • Hemphill table built in: The form returns the 30-day mortality band from the original 152-patient cohort, so a stroke team does not re-derive the lookup by hand.
• • Boundary cases handled: Age exactly 80 and volume exactly 30 mL trigger the rules correctly.
• • Mobile-friendly for bedside use: The form runs on a phone, so it can be filled in at the CT console and read at the bedside without leaving the room.

The 0 to 6 total pairs with the AHA/ASA guideline goal of strict blood pressure control in the first hours of care, supporting grading and treatment escalation.

Several factors shape the total. The most important ones sit inside the entered form, and a small set of caveats belong outside the form.

• • The 30-day mortality table is calibrated to the 2001 Hemphill cohort, and updated validation studies show similar bands but with slightly lower absolute mortality at the moderate end.
• • The result is a planning estimate, not a clinical decision. Triage, palliative care, and goals-of-care conversations sit with the stroke and neurocritical care team.
• • The 2001 Hemphill table is the most widely cited reference. Some centers use the ICH-GS refinement, which adds finer GCS bands and a 12-month functional outcome band, but the original Hemphill score remains the most common bedside grading scale.

Functional outcome follows the total on the same chart, and the Barthel Index totals the ten ADL and mobility items from the 1965 Mahoney and Barthel scale for a 0 to 100 independence band used to track ICH survivors.

Blood pressure control is the next step after grading, and a single cuff reading into the Blood Pressure Calculator turns into systolic, diastolic, and mean arterial pressure used to titrate therapy.

According to AHA/ASA 2022 Guideline (Greenberg et al., Stroke 2022), the ICH score is included as a recommended bedside severity grading tool for early risk stratification in spontaneous intracerebral hemorrhage, and the guideline reiterates that admission GCS, hematoma volume, intraventricular extension, and infratentorial origin are the clinical factors that drive early mortality and the goals-of-care conversation.

ED stroke and bleeding workups often pair the ICH calculator with rule-out tools, and the Age-Adjusted D-Dimer Calculator applies the age-adjusted cutoff to a D-dimer in the same workup to rule out venous thromboembolism in patients with new neurologic symptoms.