Background Over 7 million US high school athletes played sports in 2013/14. Participation elevates injury risk, which sometimes results in athletes’ voluntarily withdrawing from sports. Understanding what prompt athletes to withdraw, despite no medical disqualification, is important to inform injury prevention and management to reduce dropout rates.

Methods We utilised the High School Reporting Information Online database. Athlete exposure (AE) and injury incidence data were collected from a large national sample of US high schools for 22 sports from 2005/06-2014/15. Injuries motivating voluntary withdrawal from sports participation, despite no medical disqualification, were analysed.

Results Overall, 794 injuries resulting in voluntary withdrawal (representing 1.2% of all injuries reported) occurred during 35,454,673 AEs (rate = 2.24/100,000 AEs). Boys’ wrestling had the highest rate (6.17) followed by football (5.15), girls’ track and field (1.96) and girls’ soccer (1.68). Concussions accounted for 24.6% of these injuries, ligament sprains for 22.5%, and muscle strains for 12.2%. In gender-comparable sports, there were no differences in the proportion (# of withdrawals/# all injuries) of boys’ withdrawals compared to girls’ (Injury Proportion Ratio = 1.19; 95% CI: = 0.92–1.53). Most injuries were new (77.8%) and few required surgery (6.5%). Trends over time in overall rates of athletes choosing to withdraw were stable, but the rate of withdrawal due to concussion increased significantly (0.12 in 2005/06; 1.01 in 2014/15; p < 0.05).

Conclusions Rates of athletes’ voluntary withdrawal, despite no medical disqualification, differed by sport. Concussions were the primary diagnosis; rates of withdrawal due to concussion increased over time. This may reflect increased concussion awareness driving parent or athlete prompted reluctance to return to play. Sport and diagnosis specific targeted injury prevention efforts are needed to reduce voluntary athlete withdrawal from sports.