Modeling the Predictive Performance of the ICH Score: Stepwise Selection and Logistic Modeling of Mortality, Functional Outcomes, Placement Destination, and Length of Stay.

Publication/Presentation Date

3-1-2026

Abstract

BACKGROUND AND OBJECTIVES: The 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.

METHODS: This 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.

RESULTS: The 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.

CONCLUSION: The 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.

Volume

7

Issue

1

First Page

000210

Last Page

000210

ISSN

2834-4383

Disciplines

Medicine and Health Sciences

PubMedID

41659843

Department(s)

Fellows and Residents

Document Type

Article

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