Characteristics and Trends of Pediatric Traumatic Brain Injuries Treated at a Large Pediatric Medical Center in China, 2002–2011 Jianbo Shao 1 *, Huiping Zhu 2 , Hongyan Yao 3 , Lorann Stallones 4 , Keith Yeates 5,6 , Krista Wheeler 6 , Huiyun Xiang 6 * 1 Department of CT/MRI, Wuhan Children’s Hospital, Wuhan, Hubei, People’s Republic of China, 2 Department of Epidemiology and Health Statistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, People’s Republic of China, 3 Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China, 4 Colorado Injury Control Research Center, Department of Psychology, Colorado State University, Fort Collins, Colorado, United States of America, 5 Center for Biobehavioral Health. The Research Institute at National Children’s Hospital, The Ohio State University, Columbus, Ohio, United States of America, 6 Center for Injury Research and Policy, The Research Institute at National Children’s Hospital, The Ohio State University, Columbus, Ohio, United States of America Abstract Background: Pediatric traumatic brain injuries (TBIs) have not been well studied in China. This study investigated characteristics and trends of hospitalized TBIs sustained by Chinese children. Methods and Findings: We analyzed 2002–2011 hospitalized TBI patients (0–17 years of age) treated at a large pediatric medical center in China. TBIs were defined using the International Classification of Diseases, Tenth Revision (ICD-10) codes. We examined age patterns across external causes of TBIs. We reported the trend of traffic-related TBIs for each year from 2002 to 2011. Of 4,230 TBI patients, 67.1% (95% CI: 65.4%–68.8%) were city residents and 28.8% (95% CI: 26.3%–31.3%) came from rural villages. Males had disproportionately more TBIs than females (65.2% vs. 34.8%). Falls, struck by/against objects, and traffic collisions were the top three external causes of TBIs for all age groups. Falls were the leading cause of TBI for all ages but peaked at 2 years of age. There were 125 TBIs in 0–2 year olds (5.9% of all TBIs in this age group) that were caused by suspected child abuse. Suspected child abuse was significantly more likely to occur in 0–1 year olds. The proportion of traffic -related TBIs increased significantly from 12.99% in 2002 to 19.68% in 2008 but dropped each subsequent year until it reached a level of 8.91% in 2011. Conclusions: Our study confirms that falls, struck by/against objects and traffic collisions are the top external causes of TBIs in Chinese children. When compared with national data from the developed countries, gender patterns are similar, but the ranking of external causes is different. This is the first study to highlight the important role of suspected child abuse in causing TBIs in infants in China. TBIs caused by child abuse warrant further research and government attention as a social and medical problem in China. Citation: Shao J, Zhu H, Yao H, Stallones L, Yeates K, et al. (2012) Characteristics and Trends of Pediatric Traumatic Brain Injuries Treated at a Large Pediatric Medical Center in China, 2002–2011. PLoS ONE 7(12): e51634. doi:10.1371/journal.pone.0051634 Editor: Anthony E. Kline, University of Pittsburgh, United States of America Received July 27, 2012; Accepted November 8, 2012; Published December 12, 2012 Copyright: ß 2012 Shao et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: Drs. Stallones and Xiang were supported by the USA-China Agricultural Injury Research Training Project, funded by the National Institutes of Health Fogarty International Center (PIs: L Stallones and H Xiang; Grant #: 1D43TW007257-01A2). The views expressed here are those of the authors and do not necessarily reflect the official views of the funding agency. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: jbshao2005@yahoo.com.cn (JS); huiyun.xiang@nationwidechildrens.org (HX) Introduction Traumatic brain injury (TBI) is a leading cause of death and long-term disabilities around the world. [1] Previous studies indicate that TBIs can have a significant negative impact on the lives of the injured and their family members and inflict a huge economic burden on healthcare systems. [2,3,4,5,6,7,8,9,10] For these reasons, many countries have developed surveillance systems to measure the impact of TBIs and have conducted epidemiologic studies to identify risk factors and patterns of TBI to guide and evaluate effective prevention programs. [10,11,12,13,14,15]. Results of previous studies suggest that males experience more TBIs than females and that children and the elderly have higher prevalence of TBIs than other age groups. [10,16] The leading external causes of TBIs in the U.S. are, falls, road traffic collisions, struck by/against, and assault. [10] However, the leading external causes can differ across countries, and these differences are attributed to, among other factors, different socioeconomic circumstances. In high-income countries, TBIs caused by traffic collisions have been on the decline [17], while the incidence of TBIs caused by falls has been increasing because of the growing elderly population. [16]In low-income and middle income- countries, the incidence of TBIs is increasing rapidly due to significantly more road traffic collisions. [16,18,19] Child abuse is now being reported as an important cause of TBIs in children in high income countries. [20,21]. PLOS ONE | www.plosone.org 1 December 2012 | Volume 7 | Issue 12 | e51634