A different view: there is value in grading intraventricular hemorrhage.
The traditional 1-4 grading system for intra-ventricular haemorrhage (IVH) has been criticized on several points. Grade 1 IVH is not really intra-ventricular at all but all neurosonographers have recognized this for many years. Grade 3 IVH is criticized as it includes ventricular dilatation but grade 3 IVH is a haemorrhage large enough to distend the ventricle with blood not cerebrospinal fluid (CSF). The distinction between small and large IVH is valuable as the prognosis is very different. Grade 4 IVH is criticized as it is not an 'extension' but authors have described this as parenchymal haemorrhagic infarction for decades. Grade 4 IVH has different risk factors, prognosis and prophylaxis from periventricular leucomalacia. The shorthand category of 'severe IVH', meaning grades 3 and 4, is not adequate for individual patient assessment but is certainly useful for annual statistics, comparisons over time and between hospitals.


CONCLUSIONS
Despite limitations, grading IVH has value.
Whitelaw
Andrew
A
Department of Clinical Science, University of Bristol, Bristol, United Kingdom. Andrew.whitelaw@bristol.ac.uk
D002543:Cerebral Hemorrhage / Q000145:classification* / Q000473:pathology*; D002552:Cerebral Ventricles / Q000473:pathology*; D002648:Child; D006801:Humans; D012720:Severity of Illness Index