Conventional ICH functional scores demonstrate certain limitations when assessing mild-to-moderate ICH, while a newly developed nomogram based on six independent predictors demonstrated superior predictive performance for early functional dependence in this patient population.
Among 575 patients with mild-to-moderate ICH, 34.4% developed early functional dependence at discharge or 30 days after ICH.
Six independent predictors of early functional dependence in MTM-ICH patients were identified: age, admission GCS score, hematoma volume, thalamic hemorrhage, basal ganglia hemorrhage, and mechanical ventilation.
The newly developed nomogram demonstrated substantially superior predictive performance (AUC = 0.856) compared to three existing conventional ICH functional scores.
Internal validation confirmed the stability and generalizability of the nomogram model.
Conventional ICH functional scores, which are typically developed based on clinical factors for assessing mortality risk, demonstrated limitations when applied to the specific subtype of mild-to-moderate ICH.
This research suggests that standard scoring tools used to predict outcomes after brain bleeding (intracerebral hemorrhage) may not work well for patients who have a milder form of the condition. Researchers studied 575 patients in China who had mild-to-moderate brain hemorrhages and found that about 1 in 3 of these patients (34.4%) became significantly functionally dependent within 30 days. Three widely used scoring systems (FUNC, ICH-GS, and ICH-FOS) performed poorly at predicting which of these milder-case patients would become dependent, with accuracy measures (AUC values) as low as 0.579—only slightly better than chance. To address this gap, the researchers built a new prediction tool (a nomogram) tailored specifically to mild-to-moderate hemorrhage patients. This tool uses six factors: patient age, level of consciousness on admission, size of the blood clot, whether the bleeding was in the thalamus or basal ganglia regions of the brain, and whether the patient needed mechanical ventilation. The new nomogram achieved an AUC of 0.856, meaningfully outperforming all three existing scoring systems and showing consistent accuracy in internal validation tests. This research suggests that clinicians should be cautious when using general ICH scoring tools to evaluate patients with milder brain hemorrhages, as these tools may misclassify patients' risk. The newly developed nomogram could potentially help medical teams more accurately identify which mild-to-moderate hemorrhage patients are at higher risk of poor functional outcomes, which could inform care planning and resource allocation. However, the study was conducted at a single center using retrospective data, so further validation in other patient populations would be needed before widespread clinical adoption.
Chen A, Peng J, Guo L, Zhou R. (2026). Do conventional intracerebral hemorrhage functional scores apply to mild-to-moderate hemorrhage?. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1824565