Towards an understanding of maltreatment in football.

Introduction: This study explored the understanding of maltreatment from the perspective of various personnel working in roles related to safeguarding and welfare in English professional and semi-professional football. Method: Through a social constructivist position, the present study was able to explore multiple understandings and perceptions of maltreatment in football. Individual semi-structured interviews (MDuration = 68.00 minutes, SD = 9.05 minutes) were conducted with 19 participants working across league structures ranging from the English Premier League (EPL) to the English Northern Premier League Division One, as well as individuals working with some of the principal organizations in English professional football. Results: Through reflexive thematic analysis, three general dimensions were highlighted: "current understanding of maltreatment in football," "constituents of maltreatment," and "signs and symptoms of maltreatment." Findings from those working in a safeguarding capacity mirror the research literature around understanding the components of maltreatment but also demonstrate how wrongdoing is nuanced by the football context, in that certain forms of maltreatment are driven by the unique nature of this environment. Discussion: From an applied perspective, the findings also outline how to distinguish both the more overt and covert signs and symptoms of maltreatment, whilst also highlighting the impact of maltreatment on individuals' mental health and their sense of self. Overall, the findings provide a platform for practitioners and researchers to consider in the design of safeguarding and welfare provision by highlighting the need to raise knowledge and awareness of maltreatment whilst intervening to challenge the prevailing workplace culture within professional football.

Patient Outcomes Compared Between Admissions Coordinated by the Transfer Center and Emergency Department at a U.S. Tertiary Care Hospital.

BACKGROUND: Patient admissions at a U.S. tertiary care hospital occur via the emergency department (ED), or transfer center. We aim to compare the clinical outcomes of patients admitted from the ED to admissions coordinated by the transfer center. METHODS: Admissions to Mayo Clinic Hospital, Rochester, MN, between July 2019 to June 2021 were identified in this retrospective study and categorized into two cohorts-transfer center and ED. The two cohorts were then matched for age, sex, admitting service, and Charlson Comorbidity Index. Univariate and multivariate analyses were performed to compare hospital length of stay (LOS), mortality, 30-day mortality, and 30-day readmissions between the two cohorts. RESULTS: 73,685 admissions were identified, of which 24,262 (33%) were transfer center admissions. In the matched cohorts (n = 19,093, each), in-hospital mortality (2.4% versus 1.9%), 30-day mortality (5.4% versus 3.9%), 30-day readmission (12.7% versus 7.2%), and LOS (6.4 days versus 5.1 days) were significantly higher (P < 0.001) among the admissions coordinated by transfer center. A higher palliative care consultation rate (9.4% versus 6.2%, P < 0.001), and a lower proportion of home discharges home (76.2% versus 82.5%, P < 0.001) among transfer center admissions was observed. Similar findings were noted in multivariate analysis, even when adjusting for LOS. CONCLUSIONS: Transfer center admissions had higher in-hospital mortality, LOS, 30-day mortality, and 30-day readmission compared to ED admissions. This study also highlights new considerations for palliative care consultation before transfer acceptance, especially to avoid futile transfers. Additional studies analyzing factors behind the outcomes of transfer center admissions are required.

A Silver Fluoride Intervention to Improve Oral Health Trajectories of Young Indigenous Australians: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Indigenous Australian children and adolescents experience profound levels of preventable dental disease. The application of silver fluoride (AgF) to active dental caries is a noninvasive alternative to traditional dental treatment approaches. There is particular utility among Indigenous children and young people with dental fear, who may not have access to timely or culturally safe dental service provisions. OBJECTIVE: The aims of this study are to: (1) assess levels of active dental caries among Indigenous children and young people in 6 Australian states and territories; (2) determine if an AgF intervention reduces levels of active disease over 12-24 months; (3) measure the impact of improved oral health on social and emotional well-being (SEWB) and oral health-related quality of life; and (4) calculate the cost-effectiveness of implementing such an initiative. METHODS: The study will use a 2-arm, parallel cluster randomized controlled trial design. Approximately 1140 Indigenous children and youth aged between 2 and 18 years will be recruited. Each state or territory will have 2 clusters. The intervention group will receive the AgF intervention at the start of the study, with the delayed intervention group receiving the AgF intervention 12 months after study commencement. The primary outcome will be the arrest of active carious lesions, with arrested caries defined as nonpenetration by a dental probe. Secondary outcomes will include SEWB, oral health-related quality of life, and dental anxiety, with covariates including dental behaviors (brushing and dental visits). Effectiveness measures for the economic evaluation will include the number of children and young people managed in primary oral health care without the need for specialist referral, changes in SEWB, the numbers and types of treatments provided, and caries increments. RESULTS: Participant recruitment will commence in May 2023. The first results are expected to be submitted for publication 1 year after a 24-month follow-up. CONCLUSIONS: Our findings have the potential to change the way in which active dental disease among Indigenous children and young people can be managed through the inclusion of specifically tailored AgF applications to improve dental health and SEWB delivered by Indigenous health care workers. Desired impacts include cost savings on expensive dental treatments; improved SEWB, nutrition, social, and learning outcomes; and improved quality of life for both children and young people and their caregivers and the broader Indigenous community. The AgF application could be easily implemented into the training program of Indigenous health workers and yield critical information in the management armamentarium of health and well-being recommendations for Australia's First Peoples. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/48558.

Skin Anatomy and Analysis.

This article provides a comprehensive review and strong reference for facial and neck anatomy. An anatomic foundation is built for the dermatologic concepts, techniques, procedures, and surgeries detailed in noninvasive skin treatments. Superficial anatomic landmarks have been established that allow for more nuanced navigation and measurement of facial features. Throughout this article, we discuss key anatomic features of the face and neck, compare dermal thickness in various regions and ethnic anatomic differences, review insertion points of retaining ligaments of the superficial musculoaponeurotic system, and detail diagnostic tools including ultrasound and optical coherence tomography analysis of the skin.

Aesthetician Role in Facial Plastic Surgery and Systemic Therapy for Healthy Skin.

Non-surgical services are an important part of many facial plastic surgery practices and can improve patient satisfaction as well as bring new patients to the practice. An aesthetician can help to prepare patients for surgery and non-surgical procedures as well as optimize skin care during the recovery period. The scope of practice of aestheticians varies widely between states. Facial plastic surgeons who are delegating procedures to an aesthetician need to be familiar and comply with the state regulations and be up to date on ongoing changes. The connection between nutrition, skin, aging, and recovery from surgical procedures is a current topic of interest. Multiple studies suggest that nutraceuticals can provide clinically significant benefits for skin, wound healing, and hair.

Using video docuseries to explore male professional football head coaches' well-being experiences throughout a season.

Football coaches have disclosed how their work environment is unpredictable and demanding, comprising a multitude of stressors which can impede well-being. Additionally, the masculine culture within football often promotes suppression of voice, causing internalisation of thoughts and isolation. Due to professional football head coaches being a seldom-heard group, little is known about how they experience well-being within their given context (i.e., ecological niche). The present study utilised football docuseries and a bioecological framework to explore how four male professional head coaches experienced well-being whilst working in one of the top European football leagues (Premier League, La Liga). Four docuseries were sampled and resulted in the analysis of 31 episodes (Mduration = 46.6 min, SD = 4.5 min). The study implemented an adapted interpretative phenomenological analysis approach to illuminate convergences and divergences in contextual accounts. These accounts resulted in five group experiential themes: 'I belong to the game'; 'he belongs to the game'; 'you need the right people around you'; 'it's difficult to describe the manager without describing the person'; and 'people are trying to stab you'. The findings indicate that football coaches may experience identity conflicts and become deeply absorbed in their work. This impacts not only their well-being but also their family's, who they often turn to for social support. Consequently, by unveiling nuanced challenges to coaches' well-being, organisations may be better informed to offer more aligned and bespoke well-being support systems.

Community paramedic hospital reduction and mitigation program: study protocol for a randomized pragmatic clinical trial.

BACKGROUND: New patient-centered models of care are needed to individualize care and reduce high-cost care, including emergency department (ED) visits and hospitalizations for low- and intermediate-acuity conditions that could be managed outside the hospital setting. Community paramedics (CPs) have advanced training in low- and high-acuity care and are equipped to manage a wide range of health conditions, deliver patient education, and address social determinants of health in the home setting. The objective of this trial is to evaluate the effectiveness and implementation of the Care Anywhere with Community Paramedics (CACP) program with respect to shortening and preventing acute care utilization. METHODS: This is a pragmatic, hybrid type 1, two-group, parallel-arm, 1:1 randomized clinical trial of CACP versus usual care that includes formative evaluation methods and assessment of implementation outcomes. It is being conducted in two sites in the US Midwest, which include small metropolitan areas and rural areas. Eligible patients are ≥ 18 years old; referred from an outpatient, ED, or hospital setting; clinically appropriate for ambulatory care with CP support; and residing within CP service areas of the referral sites. Aim 1 uses formative data collection with key clinical stakeholders and rapid qualitative analysis to identify potential facilitators/barriers to implementation and refine workflows in the 3-month period before trial enrollment commences (i.e., pre-implementation). Aim 2 uses mixed methods to evaluate CACP effectiveness, compared to usual care, by the number of days spent alive outside of the ED or hospital during the first 30 days following randomization (primary outcome), as well as self-reported quality of life and treatment burden, emergency medical services use, ED visits, hospitalizations, skilled nursing facility utilization, and adverse events (secondary outcomes). Implementation outcomes will be measured using the RE-AIM framework and include an assessment of perceived sustainability and metrics on equity in implementation. Aim 3 uses qualitative methods to understand patient, CP, and health care team perceptions of the intervention and recommendations for further refinement. In an effort to conduct a rigorous evaluation but also speed translation to practice, the planned duration of the trial is 15 months from the study launch to the end of enrollment. DISCUSSION: This study will provide robust and timely evidence for the effectiveness of the CACP program, which may pave the way for large-scale implementation. Implementation outcomes will inform any needed refinements and best practices for scale-up and sustainability. TRIAL REGISTRATION: ClinicalTrials.gov NCT05232799. Registered on 10 February 2022.

Unimolecular Kinetics of Stabilized CH3CHOO Criegee Intermediates: syn-CH3CHOO Decomposition and anti-CH3CHOO Isomerization.

The kinetics of the unimolecular decomposition of the stabilized Criegee intermediate syn-CH3CHOO has been investigated at temperatures between 297 and 331 K and pressures between 12 and 300 Torr using laser flash photolysis of CH3CHI2/O2/N2 gas mixtures coupled with time-resolved broadband UV absorption spectroscopy. Fits to experimental results using the Master Equation Solver for Multi-Energy well Reactions (MESMER) indicate that the barrier height to decomposition is 67.2 ± 1.3 kJ mol-1 and that there is a strong tunneling component to the decomposition reaction under atmospheric conditions. At 298 K and 760 Torr, MESMER simulations indicate a rate coefficient of 150-81+176 s-1 when tunneling effects are included but only 5-2+3 s-1 when tunneling is not considered in the model. MESMER simulations were also performed for the unimolecular isomerization of the stabilized Criegee intermediate anti-CH3CHOO to methyldioxirane, indicating a rate coefficient of 54-21+34 s-1 at 298 K and 760 Torr, which is not impacted by tunneling effects. Expressions to describe the unimolecular kinetics of syn- and anti-CH3CHOO are provided for use in atmospheric models, and atmospheric implications are discussed.

It Can Be a "Very Fine Line": Professional Footballers' Perceptions of the Conceptual Divide Between Bullying and Banter.

This study explores professional footballers' perceptions of where banter crosses the conceptual line into bullying. The study's focus is of importance, given the impact that abusive behaviors have been found to have on the welfare and safeguarding of English professional footballers. A phenomenological approach was adopted, which focused on the essence of the participants' perceptions and experiences. Guided by Interpretative Phenomenological Analysis (IPA), individual semi-structured interviews (M Duration = 44.10 min, SD = 10.81) were conducted with 18 male professional footballers (M age = 19.83 years, SD = 2.96) from three Premier League and Championship football clubs. The findings from this study revealed several key superordinate themes in relation to the dividing line between bullying and banter. These themes included "perception," "intentionality," "detecting the line," and "having a bit of banter." The findings demonstrate how perceptions of bullying and banter are nuanced by individual differences among the players and the culture of the professional football context. Specifically, it was found that the professional football context can legitimize forms of humor blurring the lines between bullying and banter, challenging the typically positive view of the concept of banter in this environment. From an applied perspective, these findings highlight the need for coaches, players, and football clubs more broadly to address cultural expectations around banter in their environment, while educating individuals around their own perceptions of bullying and banter.

Assessing post-game emotions in soccer teams: The role of distinct emotional dynamics.

This study examined the relationships between team (n = 10) and player post-game emotions following two consecutive games. In addition, the relationship between emotional contagion susceptibility and player post-game emotions was assessed. Applying an experience sampling methodology, male amateur and semi-professional soccer players (N = 114, Mage = 25.46 years, SD = 9.24) completed a sport emotion questionnaire shortly after the conclusion of two competitive games. Participants also completed a dispositional emotional contagion questionnaire prior to post-game data collection. Multilevel regressions revealed that teams' collective post-game emotions were strongly associated with players' post-game emotions, after accounting for within- (e.g. time, game outcome) and between-person (e.g. formal leaders, emotional contagion susceptibility) differences. In addition, partial support was found to indicate that emotional contagion susceptibility was associated with players' post-game emotions. In this context of soccer, the findings suggest that collective emotions following a game are more indicative of individual players' emotions than an individual's general tendency to mimic the emotions of others. From an applied perspective, the findings demonstrate the importance of coaches and players being mindful of the team's emotional climate after a game and the impact it may have on players, especially when that climate is negative. HighlightsWe assessed the relationship between soccer team (n = 10) and player (N = 114) post-game emotions.We also assessed how emotional contagion susceptibility was linked to post-game emotions.Multilevel regressions revealed that team's collective post-game emotions are more indicative of players' post-game emotions than a player's emotional contagion susceptibility.

Airborne particulate concentration during non-thermal nano-pulse stimulation wart clearance is negligible compared to thermal modalities.

OBJECTIVES: As clinicians continue to implement safety protocols amid the global pandemic, considerations to mitigate potential viral transmission of airborne particulates (plume) generated from certain dermatologic procedures are of growing interest. This study intended to measure the change in airborne particulate matter using a non-thermal energy modality called nano-pulse stimulation (NPS) and compare levels of concentration to common thermal modalities (CO2 laser and electrocautery). NPS is a new non-thermal modality that applies nanosecond pulses of electrical energy to induce regulated cell death in cellular structures while sparing the surrounding acellular structure of the dermis. MATERIALS AND METHODS: The study used a Condensation Particle Counter during four types of dermatologic procedures: (1) using non-thermal NPS for the clearance of cutaneous, nongenital warts; (2) an electrocautery treatment of warts; (3) a CO2 laser for facial resurfacing; and (4) an electrocautery procedure for a facelift. Four subjects and a total of 11 warts were treated with NPS while a particle counter was used to detect the average particles per cubic centimeter once per second. The same particle counter was used, for comparison, during a wart removal procedure using electrocautery for comparison, and for control, during a skin resurfacing procedure with a CO2 laser and a facelift in which electrocautery was used. RESULTS: Only one of the 11 NPS wart procedures generated any detectable change in the particulate concentration and that change was negligible in comparison to the increase in particulate concentration measured during the CO2 laser resurfacing and the electrocautery use during a facelift procedure. CONCLUSIONS: Procedures using non-thermal NPS technology do not generate significant plume when applied to eliminate warts, suggesting it is unlikely that this new energy modality would release viral DNA into the air.

Treatment with Granulocyte-colony Stimulating Factor (G-CSF) is not associated with Increased Risk of Brain Metastasis in Patients with De Novo Stage IV Breast Cancer.

Background: Survival outcome after developing brain metastasis is poor and there is an unmet need to identify factors that can promote brain metastasis. Granulocyte-colony stimulating factor (G-CSF) is given to support neutrophil recovery after myelosuppressive chemotherapy to some patients. However, there is emerging evidence that neutrophils can promote metastasis, including through the formation of neutrophil extracellular traps (NETs), scaffolds of chromatin with enzymes expelled from neutrophils to the extracellular space. In animal models, G-CSFs can induce NETs to promote liver and lung metastasis. The primary objective of this study was to test the association between G-CSF use and the later incidence of brain metastasis. Methods: Patients with de novo Stage IV breast cancer, without known brain metastasis at the time of initial diagnosis, were identified from electronic medical records covering the period from 1/1/2013 to 12/31/2020 at Northwell Health. Univariate and multivariate logistic regression models were used to test the association between variables of interest, including G-CSF use, and brain metastasis. Results: A total of 78 patients were included in the final analysis. Among those 78 patients, 24 patients (30.8%) had received G-CSF along with chemotherapy at least once. In logistic regression models, G-CSF use was not a significant factor to predict brain metastasis (OR 1.89 [95%CI 1.89-5.33]; P=0.23). Interestingly, in multivariate logistic models, pulmonary embolism (PE)/deep venous thrombosis (DVT) was a significant predictive factor of brain metastasis (OR 6.74 [95%CI 1.82-25.01]; P=0.004) (38.5% vs 21.5%). Conclusions: The use of G-CSF was not associated with increased risk of brain metastasis in patients with de novo Stage IV breast cancer. Interestingly, PE/DVT, which can be associated with elevated NETs, was associated with brain metastasis. Further studies are warranted to determine whether DVT/PE with or without elevated NETs levels in the blood, is predictive of developing brain metastasis in patients with de novo Stage IV breast cancer.

Comparison of dyad versus individual simulation-based training on stress, anxiety, cognitive load, and performance: a randomized controlled trial.

BACKGROUND: Dyad learning has been shown to be an effective tool for teaching procedural skills, but little is known about how dyad learning may impact the stress, anxiety, and cognitive load that a student experiences when learning in this manner. In this pilot study, we investigate the relationship between dyad training on stress, anxiety, cognitive load, and performance in a simulated bradycardia scenario. METHODS: Forty-one fourth-year medical school trainees were randomized as dyads (n = 24) or individuals (n = 17) for an education session on day 1. Reassessment occurred on day 4 and was completed as individuals for all trainees. Primary outcomes were cognitive load (Paas scale), stress (Cognitive Appraisal Ratio), and anxiety levels (abbreviated State-Trait Anxiety Inventory). Secondary outcomes were time-based performance metrics. RESULTS: On day 1 we observed significant differences for change in anxiety and stress measured before and after the training scenario between groups. Individuals compared to dyads had larger mean increases in anxiety, (19.6 versus 7.6 on 80-point scale, p = 0.02) and stress ratio (1.8 versus 0.9, p = 0.045). On the day 4 post-intervention assessment, no significant differences were observed between groups. Secondary outcomes were significant for shorter time to diagnosis of bradycardia (p = 0.01) and time to initiation of pacing (p = 0.04) in the dyad group on day 1. On day 4, only time to recognizing the indication for pacing was significantly shorter for individual training (hazard ratio [HR] = 2.26, p = 0.02). CONCLUSIONS: Dyad training results in lower stress and anxiety levels with similar performance compared to individual training.

Epidemiology and clinicopathological features of lung cancer in patients with prior history of breast cancer.

Breast cancer is the most common malignancy in women, and lung cancer, the leading cause of cancer-related mortality in the United States, is the most common subsequent primary cancer among breast cancer survivors. In this review, we examine the risk factors that cause subsequent primary lung cancer after breast cancer (referred to herein as BCLC patients) as well as the prognostic factors that may affect survival. Notable clinicopathological features include patient characteristics such as age, smoking history, and the presence of EGFR or BRCA mutations, as well as factors related to the treatment of breast cancer such as radiation, surgery, chemotherapy, stage, anti-estrogen therapy, and ER/PR/HER2 status.

The Elevated High-Sensitivity Cardiac Troponin T Pilot: Diagnoses and Outcomes.

OBJECTIVE: To identify the diagnoses and outcomes associated with elevated high sensitivity cardiac troponin T (hs-cTnT) compared with the 4th-generation troponin T and to validate the Mayo Clinic hs-cTnT myocardial infarction algorithm cutoff values. PATIENTS AND METHODS: Consecutive blood samples of patients presenting to the emergency department between July 2017 and August 2017, who had 4th-generation troponin T, were also analyzed using the hs-cTnT assay. Troponin T values, discharge diagnoses, comorbidities, and outcomes were assessed. In addition, analyses of sex-specific and hs-cTnT cutoff values were assessed. RESULTS: Of 830 patients, 32% had an elevated 4th-generation troponin T, whereas 64% had elevated hs-cTnT. With serial sampling, 4th-generation troponin missed a chronic myocardial injury pattern and acute myocardial injury pattern in 64% and 16% of patients identified with hs-cTnT, respectively. Many of these "missed" patients had discharge diagnoses associated with cardiovascular disease, infection, or were postoperative. Five of the 6 patients with unstable angina ruled in for myocardial infarction. CONCLUSION: There were many increases in hs-cTnT that were missed by the 4th-generation cTnT assay. Most new increases are not related to acute cardiac causes. They were more consistent with chronic myocardial injury. High-sensitivity cTnT did reclassify most patients with unstable angina as having non-ST-elevation myocardial infarction. Older age, more comorbidities, and lower hemoglobin were associated with elevated hs-cTnT. Our data also support the use of our sex-specific cutoff values.

A historical perspective on the problem of the retained surgical sponge: Have we really come that far?

Retained surgical items, particularly surgical sponges, are a considered a "never event." Unfortunately, they continued to be reported despite significant efforts to reduce them. Our goal was to identify some of the earliest reports of surgical items, particularly surgical sponges, to see how it was presented in the literature as well as any insights into contributing factors and processes to mitigate the event. We progress forward in time to look at how this issue has been addresses or changed as we enter the 21st century. After this review, it appears that our advances are not as significant as those efforts proposed over 100 years ago. We view this as a call to action for significant change in our operative safety processes and to incorporate available technology.

The Ideal Hospital Discharge Summary: A Survey of U.S. Physicians.

BACKGROUND: Hospital discharge summaries enable communication between inpatient and outpatient physicians. Despite existing guidelines for discharge summaries, they are frequently suboptimal. OBJECTIVE: The aim of this study was to assess physicians' perspectives about discharge summaries and the differences between summaries' authors (hospitalists) and readers (primary care physicians [PCPs]). METHODS: A national survey of 1600 U.S. physicians was undertaken. Primary measures included physicians' preferences in discharge summary standardization, content, format, and audience. RESULTS: A total of 815 physicians responded (response rate = 51%). Eighty-nine percent agreed that discharge summaries "should have a standardized format." Most agreed that summaries should "document everything that was done, found, and recommended in the hospital" (64%) yet "only include details that are highly pertinent to the hospitalization" (66%). Although 74% perceived patients as an important audience of discharge summaries, only 43% agreed that summaries "should be written in language that patients…can easily understand," and 68% agreed that it "should be written solely for provider-to-provider communication." Compared with hospitalists, PCPs preferred comprehensive summaries (68% versus 59%, P = 0.002). More PCPs agreed that separate summaries should be created for patients and for provider-to-provider communication than hospitalists (60% versus 47%, P < 0.001). Compared with PCPs, more hospitalists believe that "hospitalists are too busy to prepare a high-quality discharge summary" (44% versus 23%, P < 0.001) and "PCPs have insufficient time to read an entire discharge summary" (60% versus 38%, P < 0.001). CONCLUSIONS: Physicians believe that discharge summaries should have a standardized format but do not agree on how comprehensive or in what format they should be. Efforts are necessary to build consensus toward the ideal discharge summary.

Impact of Traumatic Brain Injury on Clinical Institute Withdrawal Assessment Use in Trauma Patients: A Descriptive Study.

BACKGROUND: Alcohol withdrawal syndrome (AWS) and traumatic brain injury (TBI) present with similar signs and symptoms, yet their treatment strategies differ greatly. AWS treatment includes the Clinical Institute Withdrawal Assessment (CIWA) protocol, which grades withdrawal signs and symptoms. A major purpose of CIWA is to guide the addition and titration of central nervous system (CNS) depressants, most commonly benzodiazepines. Conversely, best practice is to avoid these same CNS depressants in the setting of TBI. Thus, patients with TBI presenting with AWS risk may receive undesirable interventions that could worsen outcome. OBJECTIVE: To describe the relationship of TBI diagnosis with CIWA protocol scores and intervention implementation. DESIGN: Retrospective cohort observational study. SETTING: Single university-based, level one trauma center. PATIENTS: Three hundred seventy-five patients with head trauma or AWS classification, identified through the trauma center's trauma registry. INTERVENTIONS: CIWA protocol and related medication use. MAIN OUTCOME MEASURES: Frequency of elevated CIWA score, length of CIWA administration, and medication administration incidence were abstracted from patients' medical records. RESULTS: The percentage of elevated CIWA scores increased significantly with TBI severity, from 4.5%(0-60) in the No TBI group, up to 12.5% (0-36) in the Mild TBI group, 27.1% (0-57) in the Moderate TBI group, and 50.0% (14-77) in the Severe TBI group. Nominally, lorazepam use showed a similar pattern of escalation with TBI severity, but it did not reach statistical significance. Haloperidol use did significantly escalate with higher TBI severity. No group differences were observed for total lorazepam equivalents or length on the CIWA protocol. CONCLUSIONS: TBI diagnosis and higher TBI severity level correlate with higher CIWA scores, but neither increased nor decreased benzodiazepine usage was observed. Antipsychotic use did escalate with TBI diagnosis and severity. The risks versus benefits of minimizing benzodiazepines in patients with TBI who are at risk for AWS warrant future study.