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Immune Effector Cell Encephalopathy (ICE) Score
Bedside neurocognitive screen used to grade ICANS after CAR T-cell or other immune effector cell therapy.
Immune Effector Cell Encephalopathy (ICE) Score
Oriented to year
Oriented to month
Oriented to city
Oriented to hospital/place
Naming (correctly names 3 objects, e.g., point to and name a pen, watch, button)
Able to follow simple commands (e.g., 'show me two fingers' or 'close your eyes and stick out your tongue')
Able to write a standard sentence legibly
Able to count backwards from 100 by tens
Result3/10 points
Consistent with ICANS neurotoxicity domain grade 2 based on the ICE score alone (an unarousable patient unable to attempt the ICE assessment is graded ICANS 4 regardless of the numeric score).
- ICE score
- 3/10
When to use
- Serial (at least twice-daily) bedside neurologic screening of patients receiving CAR T-cell or other immune effector cell therapy, to detect and grade ICANS.
Formula
Sum of: orientation to year, month, city, hospital (1 point each, max 4); naming 3 objects (max 3); following simple commands (max 1); writing a standard sentence (max 1); counting backwards from 100 by 10s (max 1). Total 0-10, where 10 = no impairment. ICE score maps to ICANS grade: 7-9 = grade 1, 3-6 = grade 2, 0-2 = grade 3 (and 0 with an unarousable patient = grade 4).
Pearls and pitfalls
- The ICE score replaced the earlier CARTOX-10 neurologic assessment tool as part of the 2019 ASTCT consensus grading.
- A single ICE score component is only one of five domains used for full ICANS grading — see the ASTCT ICANS consensus grading calculator.