Gymnastics- and Dance-Related Emergency Department Visits Among U.S. Children and Adolescents, 2021 to 2025: A Design-Based (Survey-Weighted) Analysis of the National Electronic Injury Surveillance System

Gymnastics and dance are popular, technically demanding activities for children, yet recent national data comparing their injury profiles are scarce. This study described and compared gymnastics- and dance-related emergency department (ED) visits among U.S. children aged 7 to 17 years from 2021 to 2025. We analysed five annual public-use files of the National Electronic Injury Surveillance System (7,258 sampled visits: 3,851 gymnastics, 3,407 dance), using sampling weights, strata and hospital clusters to produce national estimates with design-based 95% confidence intervals and survey-weighted logistic regression. An estimated 201,886 visits occurred over five years (110,422 gymnastics; 91,464 dance), equivalent to 47.9 and 39.7 visits per 100,000 children per year. Estimated visits rose by about 60% between 2021 and 2025, from a 2021 baseline depressed by pandemic-era disruption; all-cause injury visits in the same age group rose by 37%, and the rise does not imply a corresponding increase in injury risk per participant. Gymnastics visits involved mainly upper-extremity injuries (39.4%) and fractures (27.2%), particularly at ages 7 to 11, whereas dance visits involved mainly lower-extremity injuries (62.1%), especially to the knee and ankle. After adjustment for age, sex and year, gymnastics-related visits had higher odds than dance-related visits of fracture (odds ratio 2.70), upper-extremity injury (3.85) and admission, transfer or observation (2.57); these ratios compare ED cases, not participant risk. Narratives most often described falls, landings and flips in gymnastics and twisting or rolling in dance, and fewer than 3% described gradual-onset symptoms. The patterns suggest candidate prevention priorities for evaluation: safe falling, landing and progression of inverted skills in young gymnasts; knee and ankle control, jump and turn technique and floor conditions in dancers. ED surveillance captures acute hospital-treated injury and should be complemented by exposure-based monitoring of overuse injury.