NFHS Uses Data from Survey to Help Reduce Injury Risk

In the United States, competitive athletics at the secondary school level play an important role in the adoption and maintenance of a physically active lifestyle. Currently, the number of participants at this level surpasses 7.6 million. Regular physical activity can also improve psychological well-being, increase self-esteem, reduce depression and anxiety, and improve academic performance2,4 as well as increase strength, endurance and flexibility, and help to maintain a healthy weight.2,3

Along with the numerous health benefits comes the potential risk of injury. Something that is often overlooked is injury prevention, as many sports-related injuries are thought to be “part of the game.” In reality, many injuries are largely preventable.

However, one aspect of injury prevention efforts relies on collecting accurate data through injury surveillance. By collecting the who, what, why, where and how of injuries, injury surveillance studies like The National High School Sports-Related Injury Surveillance Study, otherwise known as High School RIO, provide the data needed to make recommendations on how to help sports to be as safe as possible for student-athletes. High School RIO data are used to help athletic trainers, coaches, officials and administrators minimize the risk of injury for student-athletes who play sports which, in turn, will increase physical activity, improve physical fitness levels and lead to lifelong healthy behaviors.

It is important to note that all sports and all levels of sports participation have unique demands, participants, and myriad variables affecting injury risk. Thus, injury rates and patterns for a specific sport will vary greatly among youth sports, high schools, colleges and pro teams. For example, making high school basketball rules changes based on NCAA injury rates would be unhelpful at best, and at worst, could actually increase injury risk at the high school level.

For many clinicians, collection of accurate and scientifically rigorous sports injury data is challenging but rewarding. High School RIO is the only surveillance study of all time-loss injuries in a national sample of U.S. high school athletes. Funded by the National Federation of State High School Associations (NFHS), High School RIO collects vital injury and illness data from hundreds of high schools across the nation. These data benefit the entire high school sports community of student-athletes, parents, pediatric sports medicine clinicians, high school athletic directors, local/ state high school athletic associations/administrators, athletic trainers, and the NFHS by describing the rates, patterns and trends of high school sports-related injuries. There are no similar injury surveillance systems utilized for club sports anywhere in the United States.

For nearly two decades, the NFHS Sports Medicine Advisory Committee (SMAC) has used High School RIO data to inform about rules changes and further risk minimization issues in the 17 sports that the NFHS writes playing rules for boys and girls at the high school level. Not only is the NFHS able to compare general injury rates in sports over time, but the SMAC can look at specific injury patterns such as concussion by position in football, or lacerations related to metal cleats in softball.

Data collection and reporting is driven by a Board of Certification (BOC) certified currently possessing the ATC credential Athletic Trainer (AT) at each participating high school. To allow the best analysis of the information, a wide variety of data points are collected, including how many athletes were practicing and competing each week and specific information about injuries and injury events (practice or competition, position played, mechanism of injury, etc.). As health- care professionals who specialize in sports injuries and illnesses, ATs are in a unique position to collect the information needed to develop data-driven interventions.

The NFHS SMAC considers the data from High School RIO to be crucial in meeting its goals. The SMAC, in consultation with leadership from High School RIO, use the data in many ways. The various NFHS rules-writing committees frequently ask for guidance from the SMAC about various safety issues. When this occurs, the SMAC frequently turns to data previously collected by High School RIO but could also ask for information about future injuries related to a rule change. In addition, each NFHS rules-writing committee is provided with injury data about their sport and the membership of the NFHS is provided with High School RIO injury data at its Summer Meeting.

Given the importance of accurate injury data collection, athletic administrators and coaches should encourage their school’s AT (if possessing the ATC credential) to participate in High School RIO. An added bonus to a school’s participation is an annual injury surveillance report generated for each participating school, allowing coaches, the athletic trainer(s) and school administrators to review injury rates and patterns with the AT and team physician. Participating ATs also earn 10 Category B CEUs from the BOC that will go toward their semi-annual continuing education requirements. Participants will also receive another incentive in the form of a virtual gift card.

High School RIO is managed by the Datalys Center for Sports Injury Research and Prevention, an independent nonprofit organization that furthers the efforts of researchers, public health officials, associations, policymakers and the public by collecting and translating sport injury and treatment data.

For more information on how to participate in High School RIO, please email the High School RIO staff at highschoolrio@datalyscenter.org.

References
1. National Federation of State High School Associations. 2020-21 High School Athletics Participation Survey. 2022. Available at: https://www.nfhs.orghttps://assets.nfhs.org/umbraco/media/5989280/2021-22_participation survey.pdf

2. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services, 2008.

3. Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. lntJ Behav Nutr Phys Ac. 2010;7:40.

4. Centers for Disease Control and Prevention. The association between school based physical activity, including physical education, and academic performance. Atlanta, GA: U.S. Department of Health and Human Services. 2010.