Functional Outcome in Patients With Primary Intracerebral Hemorrhage (FUNC) Score

Why Use

Helps clinicians quickly and accurately prognosticate patients admitted for ICH. Can be used as a tool to help guide goals of care decisions.

When to Use

Patients diagnosed with ICH. Grades ICH severity and subsequent likelihood of functional independence at 90 days, thus helping to guide goals of care conversations with patients’ families. Often used in conjunction with the ICH score , which predicts 30 day mortality after ICH.

Formula

Pearls / Pitfalls

The Functional Outcome in Patients With Primary Intracerebral Hemorrhage (ICH) Score estimates likelihood of functional independence after a diagnosis of ICH. It is intended to be used when the diagnosis of ICH is made, NOT as a continual marker of the patient’s prognosis throughout their stay. While the score can be a marker for ICH severity, it is typically NOT used to guide treatment modality. It should be used in patients with primary ICH only. Do not use in patients with secondary causes of ICH such as vascular malformation, CNS tumor, antecedent trauma or ischemic stroke, vasculitis, supratherapeutic INR (>3.0), or bleeding disorder.

Management

Clinical decisions regarding goals of care should not be made solely based on FUNC score. Other factors such as patients’ and families’ wishes, baseline neurologic status, and other co-morbidities should be taken into consideration.

Critical Actions

Patients on antiplatelet agents or anticoagulation may require reversal agents. Patients with ICH that may require intervention should be emergently transferred to a facility with neurosurgical capabilities, if not present at the admitted facility.

Advice

While the ICH score grades severity of the disease, it does not directly dictate treatment modalities. Patients with ICH should have emergent consultation with neurosurgery and be stabilized prior to transfer, if transfer is required. Most patients require ICU-level care and monitoring for airway sequelae of neurologic decompensation. ICH often causes hydrocephalus; therefore, patients with low GCS and/or signs of hydrocephalus on head CT may also need urgent ventricular decompression with an extra-ventricular drain (EVD). Coagulation studies should be ordered immediately to determine if any coagulopathy is contributing to ongoing bleeding. Clinicians should also determine if aspirin or other antiplatelet medications were taken by the patient.

More Information

Score interpretation: FUNC Score Functional Independence at 90 Days Entire Cohort Survivors Only 0-4 0% 0% 5-7 13% 29% 8 42% 48% 9-10 66% 75% 11 82% 95%