Gaps in Intracranial Pressure Monitoring for Severe Traumatic Brain Injury in China: A Clinician Survey.

BACKGROUND

Intracranial pressure (ICP) monitoring is an essential component of severe traumatic brain injury (sTBI) care. This study aimed to assess the current utilization of ICP monitoring among Chinese neurosurgeons, identify barriers to its implementation, and explore potential strategies to promote its broader adoption in the management of sTBI.

METHODS

We conducted a nationwide, cross-sectional, web-based survey in September 2025, targeting neurosurgeons who managed patients with sTBI. It comprised 5 domains: 1) hospital characteristics (level, capacity of neurosurgery and intensive care units, and ICP equipment availability), 2) professional background (title, experience, and subspecialty), 3) ICP monitoring practices (surgical and nonsurgical cases), 4) barriers and resource constraints, and 5) training needs and preferences. Data were analyzed descriptively using frequency distributions and proportions.

RESULTS

A total of 292 valid responses from 29 provinces were included. ICP equipment was fully sufficient for 57% of respondents and partially sufficient for 34% of respondents. Scenario-specific barriers prominently included Diagnosis-Related Groups/Big Data Diagnosis-Intervention Packet constraints (88%). Only 36% of respondents received structured procedural training before their first independent ICP insertion. Among those favoring probe-based monitoring (88%), ventricular placement was preferred (68%). Infection and tract hemorrhage ranked as the leading complications of concern. Interest in capacity building prioritized proctorship and high-fidelity simulation, with top content needs in standardized operative technique (87%), dynamic data interpretation (71%), and complications.

CONCLUSIONS

The implementation of ICP monitoring in China is low and uneven, not only due to shortages of funds and resources but also due to cross-cutting barriers such as insufficient training.