ArticleNeurosurgery practice2026
Modeling the Predictive Performance of the ICH Score: Stepwise Selection and Logistic Modeling of Mortality, Functional Outcomes, Placement Destination, and Length of Stay.
Article in Neurosurgery practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesThe intracerebral hemorrhage (ICH) score is widely used to predict mortality in ICH, but its ability to predict functional outcomes, length of stay (LOS), and discharge placement remains unclear. This study evaluates its predictive performance across these clinical outcomes.
methodsThis retrospective, single-center study included 273 patients admitted with ICH between 2018 and 2023. Logistic regression models assessed the ICH score's predictive performance for in-hospital mortality, modified Rankin Scale (mRS) at discharge, intensive care unit and hospital LOS, and discharge placement. Performance metrics, including accuracy, sensitivity, and specificity, were assessed using leave-one-out cross-validation. Stepwise selection was used to identify the predictive value for the individual ICH score components.
resultsThe ICH score accurately predicted in-hospital mortality (accuracy: 0.89, sensitivity: 0.80, specificity: 0.91). It showed moderate performance for mRS at discharge (accuracy: 0.67, Kappa: 0.49), particularly for mortality (mRS 6, sensitivity: 0.84, specificity: 0.91), but was less reliable for predicting functional independence (mRS 0-3, sensitivity: 0.59, specificity: 0.85) and severe disability (mRS 4-5, sensitivity: 0.66, specificity: 0.70). The score poorly predicted intensive care unit LOS (accuracy: 0.70, Kappa: 0.39) and hospital LOS (accuracy: 0.53, Kappa: 0.04). While it identified favorable (home/acute rehab) and poor (hospice/death) discharge outcomes, it failed to predict intermediate placement (subacute rehab/long-term care). Stepwise selection consistently excluded infratentorial location, suggesting limited predictive value.
conclusionThe ICH score reliably predicts in-hospital mortality but has limited accuracy for functional outcomes, LOS, and discharge placement. While useful for risk stratification, its role in individualized prognostication is limited. Future studies incorporating additional clinical and socioeconomic factors may improve predictive accuracy.
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