[Guidelines for the management of traumatic brain injury in the maritime environment (2026 edition)].

The management of traumatic brain injury (TBI) in maritime settings faces multiple challenges, including significant disparities in medical platform capabilities compared to land-based systems, spatial constraints and persistent vessel motion, limitations in power supply, oxygen, and consumables, unstable conditions for monitoring and imaging, evacuation influenced by sea-state windows, and difficulties in inter-platform handovers. These factors lead to a significantly increased risk of preventable secondary brain injury. To standardize the early treatment and transportation management of patients with TBI in maritime environments, and to enhance the continuity and operability of the maritime treatment chain, Guidelines for the management of traumatic brain injury in the maritime environment (2026 edition) was developed by experts convened under the leadership of the Neurosurgery Specialist Alliance of the Joint Logistics Support Force, in collaboration with the Neurotrauma Society of the China International Exchange and Promotive Association for Medical and Health Care, Neurotrauma Group of the Chinese Congress of Neurological Surgeons, and Craniocerebral Trauma Panel of the Neurosurgery Society of the Beijing Medical Association. With the core principles of "reducing secondary brain injury and ensuring continuity of care", this guideline synthesizes relevant domestic and international guidelines along with practical experience from resource-limited or delayed evacuation scenarios. Utilizing a grading system for evidence quality (A, B, C, D) and recommendation strength (strong recommendation, weak recommendation, conditional strong recommendation), it provides 25 recommendations focusing on: on-scene management and triage upgrade; tiered decision-making under conditions of limited imaging and monitoring; platform capability classification and evacuation pathways; minimum en-route monitoring configurations; and specific risk management for the maritime environment. This guideline aims to provide an executable, verifiable, transferable, and trainable standardized management framework for maritime TBI patients, offering a reference for clinical decision-making on various maritime medical platforms and evacuation nodes.