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 similar prognostic performance (Schmidt, 2018)
Max-ICH score (0-9 points for a single ICH)
0-6
7-13
14-20
≥21
0
1
2
3
Age
≤ 69 y
70-74 y
75-79 y
≥ 80 y
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
Max-ICH score and outcome (Suo, 2018)
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

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Max-ICH score
link: https://www.stroke-manual.com/max-ich-score/