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Head Strikes among Perioperative Personnel in the United States: A Mixed-methods Study. BACKGROUND: Healthcare workers face major occupational hazards. While various workplace safety risks for anesthesiologists have been documented, head injuries remain an under-recognized hazard. This study aimed to determine the frequency and characteristics of head strikes among anesthesiologists and perioperative nurses, examine reporting practices, and identify potential preventive strategies. METHODS: In this mixed-methods, cross-sectional national study, a 22-question survey was distributed to U.S.-based anesthesiologists and perioperative nurses in February and March of 2024. The survey, developed by a multidisciplinary team, included multiple-choice and free-response questions. The primary outcome measure was whether the individual had experienced a head strike in an operating or procedural room in the previous 12 months. Secondary outcome measures included the number of head strikes; source, timing, and head location of the strike; the amount of time taken off from work; whether a safety report was filed; and free-text responses for contributing factors, suggested changes to reduce risk, and challenges in reporting injuries. Qualitative responses were coded by investigator pairs using two collectively developed codebooks with themes and subthemes emerging inductively. RESULTS: Of the 1,549 anesthesiologists (6.6% response rate) and 287 nurses (2.7% response rate), 1,441 (78.5%) reported at least one head strike in the preceding year. Common sources included monitors (73.4% of respondents), light heads (37.4%), and boom-mounted equipment (33.4%). Most (948, 65.8%) incidents occurred intraoperatively. Causes of head strikes were multifactorial, frequently a combination of equipment placement, clinician movement, and tasks occurring under time pressure. Only 69 (4.8%) filed a safety report after a head strike. Barriers to reporting included time constraints, perception of strikes as minor incidents, and fear of negative consequences. CONCLUSIONS: Head strikes are a common but underreported occupational hazard in perioperative and periprocedural settings. Multifaceted interventions addressing equipment design, workspace organization, and reporting culture are needed to reduce such risks.