Economic and Regional Disparities in Critical Care Ultrasound Training, Equipment Access, and Implementation Barriers in China: A Nationwide Cross-Sectional Survey.

Abstract

To assess critical care ultrasound (CCUS) utilization, training coverage, and barriers to implementation among ICU clinicians across economically diverse regions in China. An online cross-sectional survey with chi-square tests, Mann-Whitney U tests, multivariate logistic regression, and principal component analysis (PCA)-based clustering. ICU clinicians from all 31 provincial-level regions in mainland China, classified into high- and low-gross domestic product (GDP) groups by per capita GDP relative to the national average. Six hundred fifty-five ICU clinicians who completed the survey. The survey included demographics, CCUS training experience, equipment availability, clinical usage frequency, and perceived implementation barriers. A total of 61.4% of respondents reported receiving CCUS training, with similar coverage between high- and low-GDP regions (61.9% vs. 60.8%; p = 0.769). Clinicians from high-GDP areas reported significantly higher self-assessed ultrasound proficiency (p = 0.008). Dedicated ultrasound equipment was unavailable in approximately one-third of ICUs, slightly more common in low-GDP regions (37.7% vs. 31.4%; p = 0.094). Major barriers included insufficient expert support (36.9%), lack of ultrasound consultants (31.3%), and difficulties in image interpretation (31.1%). Logistic regression analysis showed structured training significantly reduced the odds of encountering equipment-related barriers (odds ratio, 0.57; 95% CI, 0.34-0.97; p = 0.036). PCA-based clustering identified three clinician profiles: frequent users (high training and usage, predominantly from high-GDP areas), moderate users, and infrequent users (limited training and primarily from low-GDP regions). Structured CCUS training significantly enhances utilization and clinician expertise, irrespective of regional economic conditions. Policies promoting standardized training, equitable equipment distribution, and sustainable expert support are essential for broader CCUS integration in critical care settings across China.