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ICH Classification and Severity Scores
Related Subjects: |Subarachnoid Haemorrhage |Peri mesencephalic Subarachnoid haemorrhage |Haemorrhagic stroke |Cerebellar Haemorrhage |Putaminal Haemorrhage |Thalamic Haemorrhage |ICH Classification and Severity Scores
ℹ️ About
The SMASH-U classification 🧩 is a practical tool for determining the cause of intracerebral haemorrhage (ICH). Developed in Helsinki, it categorises ICH into 6 common aetiological groups, helping clinicians identify risk factors and tailor management.
SMASH-U Acronym Explained
- (S) Structural vascular lesions 🧠 – cavernomas, AVMs, aneurysms (~5%).
- (M) Medication 💊 – anticoagulant or antithrombotic therapy (~14%).
- (A) Amyloid angiopathy 🧓 – lobar bleeds in elderly from fragile vessels (~20%).
- (S) Systemic/Other disease 🌡️ – e.g. liver cirrhosis, thrombocytopenia, coagulopathies (~5%).
- (H) Hypertension ❤️ – chronic small-vessel rupture, deep bleeds (~35%).
- (U) Undetermined ❓ – cause not found despite workup (~21%).
📝 Teaching pearl: SMASH-U reminds you to think beyond hypertension - especially amyloid in older patients with lobar bleeds.
Reference
- Meretoja A, Strbian D, Putaala J, et al. SMASH-U: a proposal for etiologic classification of intracerebral haemorrhage. Stroke. 2012;43(10):2592-7.
The ICH Severity Score
The ICH Score 📊 is a prognostic tool that predicts 30-day mortality after ICH. It combines clinical and radiological findings into a simple scale (0–5).
| Measure | Criteria | Score |
|---|---|---|
| Glasgow Coma Scale (GCS) | 3–4 | 2 |
| 5–12 | 1 | |
| 13–15 | 0 | |
| Age | <80 years | 0 |
| ≥80 years | 1 | |
| ICH Volume >30 mL | Yes | 1 |
| No | 0 | |
| Intraventricular Haemorrhage | Yes | 1 |
| No | 0 | |
| Infratentorial Origin | Yes | 1 |
| No | 0 |
Interpretation
👉 Higher scores = higher mortality risk. Use in prognostication, not as the sole guide for treatment decisions.
| Total Score | Estimated 30-Day Mortality |
|---|---|
| 0 | 0% |
| 1 | 13% |
| 2 | 26% |
| 3 | 72% |
| 4 | 97% |
| 5 | 100% |
Notes
- 📌 The ICH Score is not a treatment decision tool – always consider premorbid function, patient wishes, and MDT discussion.
- 📌 Prognosis varies by centre and interventions available (e.g. neurosurgery, intensive care).
- 📌 Combining SMASH-U (cause) and ICH Score (severity) provides a structured way to think about both “why?” and “how bad?”.
Reference
- Hemphill JC et al. The ICH Score: a simple, reliable grading scale for intracerebral haemorrhage. Stroke. 2001;32(4):891-7.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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