Diving is more dangerous than previously thought, according to a study reported in the August 2008 issue of the journal Pediatrics by researchers at Ohio State University and the Center for Injury Research and Policy at the Nationwide Children's Hospital in Columbus, Ohio.

Study Findings

Analyzing diving-related injury data for children and adolescents seen in hospital emergency rooms over the 17 year period from 1990 through 2006, the study found as follows:

• The average yearly injury rate was 8.4 injuries per 100,000 children and adolescents under age 20;

• The vast majority of injuries (77.8%), as expected, occur during the summer months;

• In contrast to earlier reports asserting that diving injuries occur mostly among older teenagers and young adults, two-thirds of diving-related injuries occur among children younger than 15;

• Children aged 10 to 14 suffered more diving injuries than any other group, accounting for more than one-third (36.3%) of the total;

• 90% of diving-related injuries occurred in swimming pools;

• Lacerations and soft-tissue injuries were the most common injuries, representing 33.9% and 24.3% of all injuries, respectively.

• The most common body area injured was the head/neck (38.2%), which, along with facial injuries, accounted for 59.9% of all injuries;

• Only 4.7% of injuries were serious enough to require hospitalization (but see study limitations below);

• Children four years or less were more likely to suffer injuries to the face, while children aged 10 to 19 had higher odds of injuries to the extremities;

• The odds of a laceration were higher for children less than 10 years old while the children aged 10 to 19 had increased odds of fractures;

• Collisions with diving boards accounted for nearly half (44%) of all injuries, even among 15- to 19-year olds, who were at increased risk of sustaining an underwater injury from contact with the bottom of the pool;

• The odds of an injury from contact with the diving board or platform were 25 times higher if the direction of the dive was backward and 9 times higher for handstands or flips;

• Diving from a height of more than 1 meter increased the odds of injury solely as a result of contact with the water 16 times;

• Boys were at almost double the risk for head and/or neck injuries, fractures, or being injured during the underwater dive sequence than girls and at nearly twice the risk as girls for injury as a result of contact with the bottom of a pool;

Study limitations

In considering these results, the study's authors cautioned that it had several limitation:

• The total number of diving-related injuries was probably underestimated because the data sample included only injuries treated in emergency rooms and thus may not be representative of diving related-injuries treated by urgent care centers, family physicians, physical therapists, trainers, or other sources of medical care.

• No breakdown between injuries sustained in recreational versus competitive diving was possible due to reporting limitations; and

• No attempt was made to address diving fatalities, because the data system used (the National Electronic Injury Surveillance System or NEISS) is not considered reliable in identifying fatal injuries.

Injury prevention

Given the findings, the study's authors urged consideration and adoption and implementation of a number of prevention strategies and recommendations:

• Stretching and strengthening to prevent shoulder injuries for competitive divers;

• Education to prevent young children from jumping into shallow or turbid water from the edge of a pool;

• Supervision by or presence of a lifeguard;

• Visible depth indicators around the pool;

• Teaching proper diving technique when attempting new and unusual dives; and

• Soft pool bottoms and removal of obstacles from lakes, rivers, and oceans.