Neurocritical Care

, Volume 30, Issue 2, pp 449–466 | Cite as

Assessment and Comparison of the Four Most Extensively Validated Prognostic Scales for Intracerebral Hemorrhage: Systematic Review with Meta-analysis

  • Tiago GregórioEmail author
  • Sara Pipa
  • Pedro Cavaleiro
  • Gabriel Atanásio
  • Inês Albuquerque
  • Paulo Castro Chaves
  • Luís Azevedo
Original Article



Intracerebral hemorrhage (ICH) is a devastating disorder, responsible for 10% of all strokes. Several prognostic scores have been developed for this population to predict mortality and functional outcome. The aim of this study was to determine the four most frequently validated and most widely used scores, assess their discrimination for both outcomes by means of a systematic review with meta-analysis, and compare them using meta-regression.


PubMed, ISI Web of Knowledge, Scopus, and CENTRAL were searched for studies validating the ICH score, ICH-GS, modified ICH, and the FUNC score in ICH patients. C-statistic was chosen as the measure of discrimination. For each score and outcome, C-statistics were aggregated at four different time points using random effect models, and heterogeneity was evaluated using the I2 statistic. Score comparison was undertaken by pooling all C-statistics at different time points using robust variance estimation (RVE) and performing meta-regression, with the score used as the independent variable.


Fifty-three studies were found validating the original ICH score, 14 studies were found validating the ICH-GS, eight studies were found validating the FUNC score, and five studies were found validating the modified ICH score. Most studies attempted outcome prediction at 3 months or earlier. Pooled C-statistics ranged from 0.76 for FUNC functional outcome prediction at discharge to 0.85 for ICH-GS mortality prediction at 3 months, but heterogeneity was high across studies. RVE showed the ICH score retained the highest discrimination for mortality (c = 0.84), whereas the modified ICH score retained the highest discrimination for functional outcome (c = 0.80), but these differences were not statistically significant.


The ICH score is the most extensively validated score in ICH patients and, in the absence of superior prediction by other scores, should preferably be used. Further studies are needed to validate prognostic scores at longer follow-ups and assess the reasons for heterogeneity in discrimination.


Cerebral hemorrhage Prognosis Decision support techniques Mortality Morbidity 



The authors wish to thank Dr Laura Stapleton for proofreading the final manuscript for clarity and conciseness.

Author Contributions

TG conceived and designed the project, acquired, analyzed and interpreted the data, and wrote the manuscript; SP, PC, GA, and IA acquired data; PCC analyzed and interpreted data; LA designed the project, analyzed, and interpreted data; all authors critically reviewed and approved the final version of the manuscript.

Source of Support

There were no sources of funding for the current study.

Compliance with Ethical Standards

Conflicts of interest

The authors declare they have no conflicts of interest.

Supplementary material

12028_2018_633_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)


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Authors and Affiliations

  1. 1.Department of Internal MedicineVila Nova de Gaia Hospital CentreVila Nova de GaiaPortugal
  2. 2.Stroke UnitVila Nova de Gaia Hospital CentreVila Nova de GaiaPortugal
  3. 3.Intensive Care DepartmentAlgarve University Hospital CentreFaroPortugal
  4. 4.Department of Internal MedicineSão João Hospital CentrePortoPortugal
  5. 5.Stroke UnitSão João Hospital CentrePortoPortugal
  6. 6.Department of Surgery and Physiology, Faculty of MedicineUniversity of PortoPortoPortugal
  7. 7.Centre for Health Technology and Services Research and Department of Community Medicine, Information and Health Decision Sciences, Faculty of MedicineUniversity of PortoPortoPortugal

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