ADD-ONS / SCALES

Max-ICH score

Created 08/06/2022, last revision 17/01/2023

simple, reliable tool for predicting unfavorable long-term (12-month) functional outcome and death after intracerebral hemorrhage
ICH involving both lobar and non-lobar regions should be scored according to the location that ICH most likely originated from
if 2 different large ICHs occur simultaneously, then more than 1 point referring to the ICH volume should be assigned
the highest max-ICH total score for a single hematoma (with/without IVH) = 9 points
each 1-point increase in the max-ICH score was associated with an OR of 1.24 for an unfavorable outcome (Suo, 2018)
external validation comparing the ICH score and the max-ICH score shows the similar prognostic value (Schmidt, 2018)

Max-ICH score (0-9 points for a single ICH)
NIHSS 0-6 7-13 14-20 ≥21	0 1 2 3
Age (years) ≤ 69 70-74 75-79 ≥ 80	0 1 2 3
Lobar hematoma volume ≥ 30 mL	1
Non-lobar hematoma volume ≥ 10 mL	1
Intraventricular hemorrhage (IVH)	1
Oral anticoagulant agents	1

ICH volume calculation on NCCT

Calculation of hematoma volume

volume in ml (cm³) ≈ A x B x C /2 (round or ellipsoid shape)
volume in ml (cm³) ≈ A x B x C /3 (irregular, separated, or multinodular shape) [Huttner, 2006]

A, B – hemorrhage width and length – see image (in cm)

C = height

number of CT slices showing hematoma x CT slice thickness
measure the height on sagittal reconstruction (2D tools in TOMOCON or other software)

For more precise measurement, count slices as follows:

slice with ≥75% area of hemorrhage counts as one slice
slice with 25-75% area of hemorrhage counts as 0.5 slices
slice with <25% counts as zero slices

ICH volume in mL (cm3) ≈ A (cm) x B x C /2. Volume here is 4.4 mL