Objective: To quantify the accuracy of commonly used intracerebral hemorrhage (ICH) predictive models in ICH patients with and without early do-not-resuscitate orders (DNR).Methods: Spontaneous ICH cases (n ϭ 487) from the Brain Attack Surveillance in Corpus Christi study (2000 -2003) Conclusions: ICH prognostic model performance is substantially impacted when stratifying by early DNR status, possibly giving a false sense of model accuracy when DNR status is not considered. Clinicians should be cautious when applying these predictive models to individual patients. Many predictive models have been proposed to stratify risk of death following intracerebral hemorrhage (ICH) based on factors known early in the hospital course. 1-5 While many of these models have been shown to perform well on average, 1,6-8 using them to predict the outcome for an individual patient may be problematic.None of the commonly used predictive models have accounted for the impact of do-notresuscitate (DNR) orders on mortality after ICH. Early DNR orders are common after ICH 9,10 and have been associated with a doubling in the chances of death after ICH even despite adjusting for traditional predictors of mortality.10 While the association between DNR orders and death is strong and consistently seen in several studies, 9-11 the interpretation of this association is complex. DNR orders may simply represent a proxy for disease severity or comorbidities not accounted for in statistical models 12 ; alternatively, there is evidence to suggest that DNR orders after ICH may be