Statistical & Clinical Analysis
FUNC Score (0–11) Formula: 90-Day Functional Independence After Intracerebral Hemorrhage
Complement the mortality-focused ICH Score by calculating Natalia S. Rost et al.’s (2008) 11-point FUNC Score (ICH Volume, Age, Location, Admission GCS, and Pre-ICH Cognitive Impairment — where HIGHER scores 0–11 predict 90-day functional independence GOS >= 4!).
Why Neuro-ICUs pair Hemphill’s ICH Score (mortality) with Rost’s FUNC Score (0–11 functional recovery)!
While Hemphill’s ICH Score predicts 30-day mortality, families and neuro-critical care teams urgently ask whether a survivor of spontaneous Intracerebral Hemorrhage (ICH) will regain functional independence at 90 days! Validated at Massachusetts General Hospital by Natalia S. Rost, Eric E. Smith, Jonathan Rosand et al. (2008, Stroke), the FUNC Score (0–11 points—note that UNLIKE the ICH Score, HIGHER FUNC points indicate BETTER prognosis!) predicts 90-day Glasgow Outcome Scale >= 4!
FUNC sums 5 admission predictors: (1) ICH Volume (< 30 cm^3 = 4 pts, 30–60 cm^3 = 2 pts, > 60 cm^3 = 0 pts); (2) Age (< 70 yr = 2 pts, 70–79 yr = 1 pt, >= 80 yr = 0 pts); (3) Hemorrhage Location (Lobar = 2 pts, Deep ganglionic/thalamic = 1 pt, Infratentorial brainstem/cerebellar = 0 pts); (4) Admission GCS (>= 9 = 2 pts, <= 8 = 0 pts); and (5) Pre-ICH Cognitive Impairment (No = 1 pt, Yes = 0 pts)! Observed 90-day functional independence climbs from 0% (FUNC 0–4), 13% (5–7), 42% (8), 66% (9–10), up to 82% at maximum FUNC = 11!
| FUNC Total Score (0–11 Points) | Rost et al. (2008) 90-Day Functional Independence Rate | Prognostic Interpretation (Avoid Early Withdrawal Bias!) |
|---|---|---|
| 0 to 4 Points | ~0%–2% Independent at 90 Days | Severe functional prognosis |
| 5 to 7 Points | ~13% Independent at 90 Days | Guarded functional recovery |
| 8 Points | ~42% Independent at 90 Days | Intermediate recovery potential — intensive neuro-rehab |
| 9 to 10 Points | ~66% Independent at 90 Days | Favorable 90-day independence outlook |
| 11 Points (Maximum) | ~82% Independent at 90 Days | High likelihood of 90-day functional independence |
Rost et al. (2008) 11-Point FUNC Score from ICH Volume, Age, Location, GCS & Prior Cognition
Evaluates FUNC (0–11) from ICH Volume_cm3 (B2), Age_yr (B3), Location ("Lobar"/"Deep"/"Infratentorial" in B4), GCS 3..15 (B5), and Pre-ICH Cognitive Impairment (0=No, 1=Yes in B6).
=IF(OR(B2 < 0, B3 <= 0, B5 < 3, B5 > 15, AND(B6 <> 0, B6 <> 1), AND(UPPER(TRIM(B4 & "")) <> "LOBAR", UPPER(TRIM(B4 & "")) <> "DEEP", UPPER(TRIM(B4 & "")) <> "INFRATENTORIAL")), "Invalid FUNC Score Inputs", IF(B2 < 30, 4, IF(B2 <= 60, 2, 0)) + IF(B3 < 70, 2, IF(B3 <= 79, 1, 0)) + IF(UPPER(TRIM(B4 & "")) = "LOBAR", 2, IF(UPPER(TRIM(B4 & "")) = "DEEP", 1, 0)) + IF(B5 >= 9, 2, 0) + IF(B6 = 0, 1, 0))90-Day Functional Independence Probability Band Classifier (Rost et al., 2008)
Maps total FUNC score (0–11) to its validated 90-day functional independence cohort band.
=IF(OR(B2 < 0, B3 <= 0, B5 < 3, B5 > 15, AND(B6 <> 0, B6 <> 1), AND(UPPER(TRIM(B4 & "")) <> "LOBAR", UPPER(TRIM(B4 & "")) <> "DEEP", UPPER(TRIM(B4 & "")) <> "INFRATENTORIAL")), "Invalid FUNC Score Inputs", IF((IF(B2 < 30, 4, IF(B2 <= 60, 2, 0)) + IF(B3 < 70, 2, IF(B3 <= 79, 1, 0)) + IF(UPPER(TRIM(B4 & "")) = "LOBAR", 2, IF(UPPER(TRIM(B4 & "")) = "DEEP", 1, 0)) + IF(B5 >= 9, 2, 0) + IF(B6 = 0, 1, 0)) = 11, "FUNC 11: ~82% 90-Day Functional Independence", IF((IF(B2 < 30, 4, IF(B2 <= 60, 2, 0)) + IF(B3 < 70, 2, IF(B3 <= 79, 1, 0)) + IF(UPPER(TRIM(B4 & "")) = "LOBAR", 2, IF(UPPER(TRIM(B4 & "")) = "DEEP", 1, 0)) + IF(B5 >= 9, 2, 0) + IF(B6 = 0, 1, 0)) >= 9, "FUNC 9–10: ~66% 90-Day Functional Independence", IF((IF(B2 < 30, 4, IF(B2 <= 60, 2, 0)) + IF(B3 < 70, 2, IF(B3 <= 79, 1, 0)) + IF(UPPER(TRIM(B4 & "")) = "LOBAR", 2, IF(UPPER(TRIM(B4 & "")) = "DEEP", 1, 0)) + IF(B5 >= 9, 2, 0) + IF(B6 = 0, 1, 0)) = 8, "FUNC 8: ~42% 90-Day Functional Independence", IF((IF(B2 < 30, 4, IF(B2 <= 60, 2, 0)) + IF(B3 < 70, 2, IF(B3 <= 79, 1, 0)) + IF(UPPER(TRIM(B4 & "")) = "LOBAR", 2, IF(UPPER(TRIM(B4 & "")) = "DEEP", 1, 0)) + IF(B5 >= 9, 2, 0) + IF(B6 = 0, 1, 0)) >= 5, "FUNC 5–7: ~13% 90-Day Functional Independence", "FUNC 0–4: Very Low (<2%) 90-Day Independence")))))Try the example
Use the original values or change them to test your understanding.