Clinical Grading scales in intracerebral haemorrhage

Intracerebral haemorrhage (ICH) represents a subtype of stroke with a higher risk of long-term disability and mortality than any other form of stroke. Despite greater understanding of ICH pathophysiology, treatment options for this devastating condition remain limited. A lack of a standard, universally accepted clinical grading scale for ICH has contributed to reduce availability of optimised treatment regimens, and designing effective clinical trials protocols reducing communication among physicians. A number of ICH grading scales and prognostic models have been developed for mortality and/or functional outcome, particularly 30 days after ICH onset. Several reliable scales have been externally validated in heterogeneous populations. Presently, the ICH score developed by Hemphill and colleagues has showed a greater diffusion due to a good sensibility, specificity and reproducibility together with an easy use. The actual modified versions of this scale have shown only a limited impact on prediction although it is possible to improve prediction of this scale introducing new selected biomarkers. Before an extensive use of these prognostic scale in clinical practice, expansive, prospective, multi-center clinical outcome studies are mandatory to clearly define all aspects of ICH, establish ideal grading scales, and standardised management protocols to enable the identification of novel and effective therapies in ICH.