The National Athletic Treatment, Injury and Outcomes Network (NATION): Methods of the Surveillance Program, 2011-2012 Through 2013-2014

Context: Previous epidemiologic researchers have examined time-loss (TL) injuries in high school student-athletes, but little is known about the frequency of non-time-loss (NTL) injuries in these athletes. Objective: To describe the methods of the National Athletic Treatment, Injury and Outcomes Network (NATION) Surveillance Program and provide descriptive epidemiology of TL and NTL injuries across athletes in 27 high school sports. Design: Descriptive epidemiology study. Setting: Aggregate injury and exposure data collected from 147 high schools in 26 states. Patients or Other Participants: High school student-athletes participating in 13 boys' sports and 14 girls' sports during the 2011-2012 through 2013-2014 academic years. Main Outcome Measure(s): Athletic trainers documented injuries and exposures using commercially available injury-tracking software packages. Standard injury-tracking software was modified by the software vendors to conform to the surveillance needs of this project. The modified software exported a set of common data elements, stripped of personally identifiable information, to a centralized automated verification and validation system before they were included in the centralized research database. Dependent measures were injury and exposure frequencies and injury rates with 95% confidence intervals stratified by sport, sex, and injury type (TL or NTL). Results: Over the 3-year period, a total of 2337 team seasons across 27 sports resulted in 47 014 injuries and 5 146 355 athlete-exposures. The NTL injuries accounted for 38 765 (82.45%) and TL injuries for 8249 (17.55%) of the total. Conclusions: The NTL injuries accounted for a substantial amount of the total number of injuries sustained by high school student-athletes. This project demonstrates the feasibility of creating large-scale injury surveillance systems using commercially available injury-tracking software.