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

Abstract

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. We conducted a nationwide, cross-sectional, web-based survey in September 2025, targeting neurosurgeons who managed patients with sTBI. It comprised five domains: (1) Hospital characteristics (level, neurosurgery and intensive care units (ICU) capacity, ICP equipment availability); (2) Professional background (title, experience, subspecialty); (3) ICP monitoring practice (surgical and non-surgical cases); (4) Barriers and resource constraints; and (5) Training needs and preferences. Data were analyzed descriptively using frequency distributions and proportions. A total of 292 valid responses from 29 provinces were included. ICP equipment was fully sufficient in 57% of respondents, partially sufficient in 34% of respondents. Scenario-specific barriers prominently included Diagnosis Related Groups (DRG)/Big Data Diagnosis-Intervention Packet (DIP) constraints (88%). Only 36% received structured procedural training before 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 complication. 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.