[Expert consensus on the management of traumatic brain injury in mass casualty incidents (2026 edition)].

The management of traumatic brain injury (TBI) in mass casualty incidents (MCI) is characterized by strong time dependence, complex injury patterns, and acute strain of medical resources, rendering it substantially more challenging than routine clinical practice. Currently, most existing domestic and international TBI guidelines and consensus statements are developed for daily medical scenarios, and lack systematic full-process standard tailored to the resource-constrained MCI environment. To fill this gap, the Chinese Neurosurgical Society convened a multidisciplinary expert panel covering neurosurgery, critical care medicine and evidence-based medicine and other disciplines. In strict accordance with international methodological standards for guideline development, the panel systematically searched the literature, completed evidence quality appraisal and subsequently formulated the Expert consensus on the management of traumatic brain injury in mass casualty incidents (2026 edition). This consensus covers the entire process of TBI care in MCI treatment: general principles and emergency response system, safety and protection of rescue personnel and professional team development, on-site triage and emergency life support, safe transport and tiered triage, in-hospital standardized treatment and priority management, intracranial pressure monitoring and standardized management, in-hospital complication prevention and comprehensive management, and early rehabilitation and psychological support. The panel graded the quality of evidence and strength of recommendations using the Oxford University centre for evidence-based medicine levels of evidence framework (2009) and reached a consensus through Delphi expert consultation, forming in 42 recommendations. Guided by the core principle of "maximizing treatment outcomes with limited resources", this consensus defines tiered decision-making rules based on injury severity, clarifies triage priorities for mass casualties, and specifies full-process care protocols. It can provide evidence-based reference and practical basis for medical institutions at all levels and health administrative authorities in China to construct MCI-TBI emergency response systems, standardize clinical practice, and carry out specialized personnel training.