One of the essential dilemmas in (neuro-)critical care is the low level of evidence for or against certain therapeutic approaches. A specific neurocritical care feature—that may complicate further generation of evidence—is its interdisciplinary patient-centered care, i.e., an overlapping patient collective that in Germany is treated either in neurological, neurosurgical, or interdisciplinarily in anesthesiologicaldirected neuro-intensive care units (NICU). For instance, patients with subarachnoidal hemorrhage (SAH) can be treated by neurologists or neurosurgeons as well as anesthesiologists or other specialities. No wonder that the individual guidelines can differ in their recommendations regarding monitoring and treatment [1–3]. Another aspect for the lack of evidence is that large randomized controlled trials generating the highest levels of evidence are less frequent as in general critical care. For the critical care management of stroke, only decompressive surgery is established as a level 1 evidence today [4] whereas many urging problems like management of basilar artery thrombosis or cerebellar stroke reach only weak levels of evidence. Besides practical problems such as randomizing severely ill patients who cannot consent, there is also a lack of industry-sponsored trials in the field of (neuro) critical care, possibly as the severity of diseases undermines the chances for positive clinical end-points [5]. Moreover, high-quality papers funded by public authorities are rare and rather help to guide when there is uncertainty in specific therapeutic options such as whether or not surgery should be performed in ICH or malignant middle cerebral infarction [6–8]. Yet, the majority of basic treatment in daily neurocritical care is supported by lower levels of evidence, if any at all, and studies are often of retrospective and single-center design. A promising model of bridging the gap between level C and level A evidence is to assimilate and standardize data quality of large tertiary hospitals and to pool data on various treatment aspects. However, prior to designing any future (and even trans-national) collaborations, there is need for an as-built analysis of the current situation of routine clinical management of patients requiring neurocritical care. In this issue of NEUROCRITICAL CARE, authors from Germany (as part of the recently established German-wide IGNITE-group, i.e., Initiative of German NeuroIntensive Trial Engagement) conducted a nationwide online survey which included 50 multiple-choice or open questions regarding admission diagnoses, use of standard operating procedures, protocols, adherence to guidelines and scores, modalities of multimodal neuromonitoring, and target values of distinct bloodand cerebrospinal fluid parameters [9]. All German hospitals with either a specialized neurological, neurosurgical, or interdisciplinary anesthesiological-directed neuro-ICU were contacted, and a sufficient large number of responses (more than 50 % from tertiary University Hospitals) were obtained. The most frequent admission diagnoses were ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, tumor, traumatic brain injury, and epior subdural hematomas. Not surprisingly, the admission diagnoses were different depending on the speciality running the NICU. However, as soon as focusing on the clinical scores used and documented baseline parameters, there was a notably high variance across the three major disciplines, i.e., This is an editorial for the article available at doi:10.1007/s12028013-9893-3