While direct catastrophic injuries are relatively rare in high school sports, they do occur, and some sports appear to carry a greater risk than others. Data provided by the NCCSIR are provided as count data as well as in terms of injury rates per 100,000 participants. Count data provide a relative estimate of the frequency of catastrophic injuries across sports as well as an estimate of morbidity load on the health-care system. However, in order to investigate the distribution of injuries it is necessary to know the size of the population from which the injured individuals were derived, or the population-at-risk. The NCCSIR also provides data on the number of catastrophic injuries sustained in a particular sport relative to the total number of participants, or injury rates per 100,000 participant-seasons. While these data provide a basis for calculating injury rates, they may lack precision because of the varying exposure of participants to risk of injury. For example, a sidelined or second team player who sees little or no contact during a game is not at the same risk of sustaining a catastrophic sports injury as a healthy first team player. In addition, the number of practices and games may vary considerably from one sport or team to another.

Data on the total number of male direct catastrophic injuries sustained in US High School Sports during 1982–2013 are summarized in Table 12.2. High school male sports were associated with 174 fatalities, 469 nonfatal and 442 serious injuries for a total of 1,085 direct catastrophic injuries during that 31 year period [4, 5]. A review of Table 12.2 shows that fall sports were responsible for the greatest number of male direct catastrophic injuries, followed by spring and winter sports. The sports with the highest count of direct catastrophic injuries in each season were football (Fall), wrestling (Winter), and baseball (Spring). The sport showing the highest number of fatalities is football, followed by track and field and baseball. It should be emphasized, however, that these are count data and do not necessarily reflect the risk of direct catastrophic injury in that number and exposure of participants are not taken into account.

High school females accounted for three deaths, 23 non-fatal and 24 serious injuries for a total of 50 direct catastrophic injuries over 31 years [4, 5]. A review of Table 12.3 shows that winter sports were responsible for the greatest number of female direct catastrophic injuries, followed by spring and fall sports. The sport with the highest count of direct catastrophic injuries in each season were soccer (Fall), gymnastics (Winter), and track and field (Spring). There were two female fatalities in softball and one in track and field. Again, it should be emphasized that these are count data and do not necessarily reflect the risk of direct catastrophic injury in that number and exposure of participants are not taken into account.

Using the participation data in Table 12.1 as the denominator data, and the numbers of injuries in Tables 12.2 and 12.3 as the numerator data, we can calculate direct catastrophic injury rates per 100,000 participant-seasons for each sport during 1982–2013 (Tables 12.4 and 12.5). As can be seen, looking at the rates rather than raw numbers changes the picture considerably. For example, as shown in Table 12.2, football had the highest number of fatalities. However, when the injury rate is calculated based on 31-year participation estimates (Table 12.4), the male sports with the highest rate of fatalities per 100,000 participant-seasons were softball (2.66), followed by gymnastics (0.91) and ice hockey (0.44). However, the rate for softball should be considered anomalous since there happened to be one direct male fatality in softball but only 37,551 participant-seasons over 31 years. In reality the highest risk male sports for direct fatalities are gymnastics, ice hockey, and football with 0.28 per 100,000 participant-seasons. The sports with the highest rates for male nonfatal direct catastrophic injuries were gymnastics (1.82 per 100,000 participant-seasons), ice hockey (1.33), and football (0.87). Among female participants, there were no fatalities reported except for track (0.01 per 100,000 participant-seasons) and softball (0.02). The female sports with the highest rates of nonfatal direct catastrophic injuries were ice hockey (0.86 per 100,000 participant-seasons) followed by gymnastics (0.82).