No Diving! National Estimates and Characteristics of Diving-related Injuries in Children and Adolescents from 2008-2020

Background: Recreational swimming/diving is the most common physical activity among US children and a significant cause of preventable morbidity across the United States. There are an estimated 50 million Americans that participate in swimming per year, 16 million of whom are children. Despite the popularity of swimming and diving, there are few up-to-date national diving-related injury analyses, and no comprehensive injury analysis has been performed since the institution of International Swimming Pool & Spa Code (ISPSC) in 2012, which regulate diving equipment and design. This study offers a much-needed update on the national epidemiology of diving-related orthopedic injuries.

Methods: The Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) database was queried for patients aged 0-18 from 2008-2020 who presented to any of the approximately 100 NEISS-participating emergency departments (EDs) for a diving-related injury. The patient cohort was identified using a search for consumer product code-1278 (diving). Injuries involving diving accessories, running, hitting, or tripping over the diving board, and injuries resulting from contact between two or more divers, were excluded. Infections were excluded. Dive characteristics such as dive height, dive skill, dive direction, and dive sequence were determined from case narratives. Descriptive statistical analysis was performed using Stata 16.

Results: From 2008-2020 there were 1,157 cases of diving-related injury corresponding to a national estimate of 35,648 injuries (CI=28,067 - 43,230; Table 1). Children aged 10-14 accounted for 42% of all injuries, while adolescents aged 15-19 accounted for 38%. Nearly twice as many injuries occurred in boys compared to girls (64.2% vs 35.8% of total injuries, respectively). From 2008-2012, there were an average estimated 3,191 injuries per year. From 2013-2019, the yearly average decreased to 2,633 injuries (Figure 1). Due to the COVID-19 pandemic, there were relatively few (1,261) injuries in 2020. Compared to 2012, there were an estimated 1,081 fewer diving injuries in 2013, the first year the ISPSC codes were widely adopted. Lacerations were the most reported diagnosis for all years (24.9% of injuries). The head and neck were the most-injured body parts (46.4% of injuries), followed by the face (17.4% of injuries), and lower extremities (16.6% of injuries). Concussions and nerve injury accounted for 6.7% and 0.1% of injuries, respectively. When the mechanism of injury was reported, unintentional contact with the diving board or platform was the most common cause (27.2% of injuries).

Conclusion: Diving injuries are common in children and adolescents, especially in boys aged 10-19. Since the 2012 adoption of international safety standards for swimming pool design and operation, the average number of yearly diving-related injuries has fallen by nearly 600 injuries/year. There was a significant reduction in diving-related injury corresponding with the COVID-19 pandemic.