Overview
Intracerebral hemorrhage (ICH) is bleeding within the brain parenchyma. Multiple localized ICH refers to the presence of more than one distinct area of bleeding within the brain. Prognostication in critically ill patients with ICH is a key aspect of management.Diagnosis
The ICH score and maximally treated ICH score are clinical grading scales used for prognostication 1.Management
Neuroprognostication should generally be deferred for at least 48-72 hours after ICU admission, except in cases of extreme clinical devastation 1.
Understanding the patient's valued outcomes is essential for counseling 1.Key Recommendations
Defer neuroprognostication for at least the first 48-72 hours of intensive care unit admission, except for the most clinically devastated patients 1. (Evidence: Expert opinion)
Understand what outcomes would have been most valued by the patient 1. (Evidence: Expert opinion)
Counsel the patient 1. (Evidence: Expert opinion)References
1 Hwang DY, Kim KS, Muehlschlegel S, Wartenberg KE, Rajajee V, Alexander SA et al.. Guidelines for Neuroprognostication in Critically Ill Adults with Intracerebral Hemorrhage. Neurocritical care 2024. link