Objective <p>This study aims to enhance the prognostic prediction of spontaneous intracerebral hemorrhage (sICH) by comparing the accuracy of three models: a CT-based deep learning model, a clinical variable-based machine learning model, and a hybrid model that integrates both approaches. The goal is to evaluate their performance across different outcome thresholds, including poor outcome (mRS 3–6), loss of independence (mRS 4–6), and severe disability or death (mRS 5–6).</p> Materials and methods <p>A retrospective analysis was conducted on 1,853 sICH patients from a stroke center database (2008–2021). Patients were divided into two datasets: Dataset A (958 patients) for training/testing the clinical and hybrid models, and Dataset B (895 patients) for training the deep learning model. The imaging model used a 3D ResNet-50 architecture with attention modules, while the clinical model incorporated 19 clinical variables. The hybrid model combined clinical data with prediction probability from the imaging model. Performance metrics were compared using the DeLong test.</p> Results <p>The hybrid model consistently outperformed the other models across all outcome thresholds. For predicting severe disability and death, loss of independence, and poor outcome, the hybrid model achieved accuracies of 82.6%, 79.5%, 80.6% with AUC values of 0.897, 0.871, 0.0873, respectively. GCS scores and imaging model prediction probability were the most significant predictors.</p> Conclusion <p>The hybrid model, combining CT-based deep learning with clinical variables, offers superior prognostic prediction for sICH outcomes. This integrated approach shows promise for improving clinical decision-making, though further validation in prospective studies is needed.</p> Trial registration <p>Not applicable because this is a retrospective study, not a clinical trial.</p>