Table 3.

Class I recommendations with level of evidence A or B for management of ICH

RecommendationClassLevel of evidence
A baseline severity score should be performed as part of the initial evaluation of patients with ICH 
Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH 
Patients with ICH should have intermittent pneumatic compression for prevention of venous thromboembolism beginning the day of hospital admission 
For ICH patients presenting with SBP between 150 and 220 mm Hg and without contraindication to acute BP treatment, acute lowering of SBP to 140 mm Hg is safe 
Initial monitoring and management of ICH patients should take place in an intensive care unit or dedicated stroke unit with physician and nursing neuroscience acute care expertise 
Clinical seizures should be treated with antiseizure drugs 
A formal screening procedure for dysphagia should be performed in all patients before the initiation of oral intake to reduce the risk of pneumonia 
Patients with cerebellar hemorrhage who are deteriorating neurologically or who have brainstem compression and/or hydrocephalus from ventricular obstruction should undergo surgical removal of the hemorrhage as soon as possible 
BP should be controlled in all ICH patients. Measures to control BP should begin immediately after ICH onset 
Given the potentially serious nature and complex pattern of evolving disability and the increasing evidence for efficacy, it is recommended that all patients with ICH have access to multidisciplinary rehabilitation 
RecommendationClassLevel of evidence
A baseline severity score should be performed as part of the initial evaluation of patients with ICH 
Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH 
Patients with ICH should have intermittent pneumatic compression for prevention of venous thromboembolism beginning the day of hospital admission 
For ICH patients presenting with SBP between 150 and 220 mm Hg and without contraindication to acute BP treatment, acute lowering of SBP to 140 mm Hg is safe 
Initial monitoring and management of ICH patients should take place in an intensive care unit or dedicated stroke unit with physician and nursing neuroscience acute care expertise 
Clinical seizures should be treated with antiseizure drugs 
A formal screening procedure for dysphagia should be performed in all patients before the initiation of oral intake to reduce the risk of pneumonia 
Patients with cerebellar hemorrhage who are deteriorating neurologically or who have brainstem compression and/or hydrocephalus from ventricular obstruction should undergo surgical removal of the hemorrhage as soon as possible 
BP should be controlled in all ICH patients. Measures to control BP should begin immediately after ICH onset 
Given the potentially serious nature and complex pattern of evolving disability and the increasing evidence for efficacy, it is recommended that all patients with ICH have access to multidisciplinary rehabilitation 

Table adapted from Hemphill et al.27  Class I recommendations are for when there is evidence for and general agreement that the procedure or treatment is useful and effective. Level of evidence A is based on multiple randomized clinical trials or meta-analyses; level of evidence B is based on 1 randomized trial or observational studies.

BP, blood pressure; CT, computed tomography; ICH, intracranial hemorrhage; MRI, magnetic resonance imaging; SBP, systolic blood pressure.

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