2025-26 High School RIO Enrollment

Participant Information Letter for High School RIO^TM (Reporting Information Online): National High School Sports-Related Injury Surveillance Study, 2025-2026

Your high school is being invited to participate in High School RIO, an internet-based surveillance study of injuries sustained by US High School athletes. This study is being conducted by researchers at the Datalys Center for Sports Injury Research and Prevention, Inc. and is funded by the National Federation of State High School Associations (NFHS). Below is some information about the High School RIO study. At the bottom of the page, you will have the opportunity to volunteer to participate, ask additional questions, or opt out of future correspondence.

Why are we doing this study? 
We want to learn more about how high school athletes are injured so we can determine the best way to protect them from being hurt. The injury information collected will provide a basis for the NFHS' Rules Committees and Sports Medicine Advisory Committee to make evidence-based recommendations to reduce the number of high school sports-related injuries.

What are the study objective and goals?
The long-term goal of the proposed line of research is to reduce the morbidity, mortality, and disability among adolescent athletes caused by sports-related injuries. The objective of this study is to move toward that goal through the development and implementation of a proposed permanent internet-based high school sports-related injury surveillance system. The surveillance system used in this study was modeled after the successful National Collegiate Athletic Association (NCAA) Injury Surveillance System (NCAA ISS), now known as the NCAA Injury Surveillance Program (ISP), a system that consistently produces quality data on sports-related injuries, exposures, and risk factors among collegiate athletes, which is also managed by the Datalys Center.

What did we learn from previous years of the High School RIO study?

• During the first 20 years of High School RIO, certified athletic trainers from participating schools have reported over 128,000 injuries sustained during 64.4 million high school athletic exposures in 24 sports (boys' football, boys' and girls' soccer, girls' and boys' volleyball, boys' and girls' basketball, girls' gymnastics, boys' wrestling, boys' baseball, girls' softball, girls' field hockey, boys' ice hockey, boys' and girls' lacrosse, boys' and girls' swimming and diving, boys' and girls' track and field, boys' and girls' cross country, boys' and girls' tennis, and cheerleading)
• From this data, we identify rates and patterns of injury by sport and between genders in sports played by both boys and girls.
• We can look at specific injury information, such as body site, diagnosis, and severity, which vary not only by sport and gender, but also within sports based on specific injury event information such as position played, activity engaged in at the time of injury, protective equipment worn, etc.
• We share injury information with rules committees, sports medicine advisory committees, protective equipment manufacturers, and others working to keep high school athletes as safe and healthy as possible as they enjoy participating in sports. Such information can drive evidence-based injury prevention efforts. Once such efforts are implemented, we can look at trends over time to evaluate how effective they are in reducing injury incidence or severity.

What is expected of participating high schools?
During the 2025-2026 academic year, schools participating in High School RIO will be asked to have a certified athletic trainer collect and report athletic exposure, sports-related injury, and risk factor information for up to 10 of the 20 sports currently included in the study (boys' football, boys' and girls' soccer, girls' volleyball, boys' and girls' basketball, boys' and girls' wrestling, boys' baseball, girls' softball, girls’ field hockey, boys’ ice hockey, boys’ and girls’ lacrosse, boys’ and girls’ track and field, boys’ and girls’ cross country, cheerleading and marching band). You are not expected to report for all 20 sports. Instead, you will report for up to 10 randomly selected sports that are offered at your school and that you provide services for.

The certified athletic trainer serving as the school’s reporter will be asked to log onto the study website weekly throughout each sport’s season to provide exposure information (the number of student athletes practicing and competing) and injury incidence information. It will take approximately 5 minutes each week to complete this weekly exposure report. Additionally, for each injury reported, the certified athletic trainer will be asked to complete an injury report form consisting of athlete demographic information (age, height, weight, grade in school), injury information (body site, diagnosis, severity) and specific injury event information (e.g., level of competition, position played, protective equipment worn, activity engaged in at the time of injury, etc.). It will take approximately 5-10 minutes to complete each injury report.

Reportable injuries will only include those that:

1. Occur as a result of participation in an organized high school athletic practice/competition AND
2. Require medical attention by a team certified athletic trainer or a physician AND
3. Result in restriction of the student-athlete’s participation for one or more days beyond the day of injury OR
4. Result in any fracture, concussion, dental injury, or heat injury/illness regardless of whether or not it results in restriction of the student-athlete's participation

Does the RIO system include an Electronic Medical Record (EMR) component?
Yes, the RIO system includes an electronic medical record (EMR) component developed specifically for you to use in your clinical setting; however, unlike traditional EMRs, the RIO system does not carry injury records forward year to year. You will be able to use the EMR component to manage and track information about your athletes, the injury assessments you conduct, the treatments you provide, and medical outcomes of these treatments. As a participant in the National High School Sports-Related Injury Surveillance Study, you will get full access to this EMR as a token of our appreciation, but please note at the end of each school year, injury records are removed from the system.

Are there any opportunities to participate in additional substudies?
Study participants will also have the opportunity to participate in additional substudies. Participation in such substudies is always voluntary and will not affect your participation in the larger High School RIO Study.

Isn’t students’ medical information confidential? How will it be kept private?
Student athletes' injury information is protected by federal privacy regulations such as the Health Information Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA). Information collected for this study is confidential to the extent provided by law. The protocol for this study has been approved by the Nationwide Children's Hospital’s Institutional Review Board, the Colorado Multiple Institutional Review Board (COMIRB), and the WCG Institutional Review Board, committees that review research to ensure study participants are protected.

The RIO system includes an electronic medical record (EMR) component developed specifically for ATs to use in a clinical setting to manage and track information about their athletes, the injury assessments they conduct, the treatments they provide, and medical outcomes of those treatments. While ATs are able to enter a student’s name and other identifying information into the system, they are not required to do so as a part of the study. Furthermore, ATs will have full access to the system without having to enter any identifying information. No identifying information about the student athletes will be seen by researchers. Researchers will only have access to de-identified information (i.e., data that have been stripped of all personal identifiers). All identifying information will be stored on an off-site HIPAA compliant secure server operated by a third party.

The researchers conducting this study are committed to protecting your student athletes' privacy. Again, no identifying information about the student athletes will be seen by researchers (researchers will only have access to de-identified information). Data collected will be used only for the purpose of conducting research on injuries resulting from training for or participation in high school sports. The final summary report and any publications based on this study will use only summary (aggregate) injury and participation information that does not identify individual athletes or participating schools. Over the 20 years the High School RIO study has been conducted, there has never been a breach of student athlete confidentiality.

How will participants be chosen?
Each US high school with a certified athletic trainer with internet access who is willing to serve as a reporter for the surveillance system will be invited to enroll (priority will be given to schools with a certified athletic trainer who is available to the high school 5 days a week to provide comprehensive care to all athletes without limitation on hours). In order to obtain a nationally representative study sample, the pool of eligible study schools will be distributed in a sampling frame stratified by size and sub-stratified by geographical location. A simple random sample of study schools will be chosen from each substrata of the sampling frame. A total of 200 high schools will be selected to participate in the High School RIO study.

Schools who have previously participated in the High School RIO study will be automatically selected to participate in the 2025-2026 High School RIO study if they are willing to do so. However, all returning schools must complete a new Participant Agreement form (a form signed by the Principal, Athletic Director, and Athletic Trainer that acknowledges participation in High School RIO).

Will participants be compensated?
Each high school participating in the High School RIO study will receive a monetary reimbursement for their certified athletic trainer’s time based on the number of sports reported (approx. $300 for 10 sports, schools reporting for more sports will receive additional participant incentive).

Each athletic trainer participating in the High School RIO study will also receive 10 Category B CEUs.

What support will participants receive from the research team?
Each participating AT will receive a training packet and will have access to two additional training options: 1) a personal training session conducted by a member of the research staff on the use of the internet-based surveillance system via video call, and 2) a set of self-guided PowerPoint slides detailing the data entry process. Web hosting and technical support for the surveillance system will be provided by the Datalys Center. Throughout the study the Principle Investigator, Christy Collins, PhD, and the RIO research assistant, Megan Anderson, will be available via e-mail at highschoolrio@datalyscenter.org to answer questions and/or address concerns. Following the conclusion of the study, each participating high school will receive a copy of the summary report of the study’s aggregate national findings as well as an individual report detailing their school's data.