Is Polycystic Ovary Syndrome Another Risk Factor for Venous Thromboembolism? United States, 2003–2008

The Journal of Emergency Medicine evaluation. Falls were defined as ‘‘unintentional coming to rest on the ground, floor or other lower level.’’ Incorrect shifting of bodyweight was found to be the most common cause for falls (41%). This was described as moving bodyweight too far from the center of gravity, causing instability from the support base. Other causes of falls include trip or stumble (21%), loss of external object support (11%), hit or bump (11%), and loss of consciousness or collapse (11%). As for the falls due to trip and stumble, these can be linked to difficulty raising a foot or foot catching on the ground (31%), foot catching on equipment (29%), foot catching on furniture (25%), foot catching on the other foot (6%), and tripped by another person (6%). Activities were also studied to determine which were most associated with falling. Walking has the most frequent activity association (24%). Other activities identified as links to falls include standing, sitting down or lowering, and initiation of walking. As for falls in patients using wheelchairs or walkers (21%), there was no difference seen in the type of assistance. While looking at specific patient populations, no differences were seen between different sexes or ages. Patients with Alzheimer disease had a higher rate of falls seen on video (34%, p = 0.04 from c2). The time of day falls most frequently occurred was in the afternoon. As the majority of falls are due to self-shifting body weight, muscle-strengthening exercises for the elderly may help in prevention. In addition, knowing that trips over equipment and furniture are also common causes, improving staff knowledge and equipment can decrease fall occurrences. [Jenny L. Chua-Tuan, MD, MBA Denver Health Medical Center, Denver, CO] Comment: As our elderly population continues to grow, it is important that we continue to expand our awareness of afflictions that particularly influence this group. As medical facilities and equipment get replaced, we must keep in mind features that can help prevent injuries in all of our patients. By understanding the mechanisms of falls, we may be suited to avoid these sometimes debilitating occurrences. , IS POLYCYSTIC OVARY SYNDROME ANOTHER RISK FACTOR FOR VENOUS THROMBOEMBOLISM? UNITED STATES, 2003–2008 Okoroh EM, Hooper WC, Atrash HK, et al. Am J Obstet Gynecol 2012;207:377.e1–8. This study from the United States aimed to determine if a causal relationship or prevalence existed between polycystic ovary syndrome (PCOS) and venous thromboembolism (VTE). From the 2003–2008 Thomson Reuters MarketScan Commercial databases, a total of 12,171,830 women were eligible for the study. There were 23,931 women with VTE and 192,936 women with PCOS. VTE was defined as a chronic condition including deep vein thrombosis and pulmonary embolism. PCOS was defined by the presence of hyperandrogenism, ovulatory dysfunction, or polycystic ovaries. VTE prevalence was found to be 193.8 per 100,000 without PCOS, vs. 374.2 per 100,000 with PCOS. Patients with all three characteristics of PCOS, hyperandrogenism, ovulatory dysfunction, and polycystic ovaries were found to have the highest prevalence of VTE at 478.9 per 100,000. The highest prevalence

1061 age group for VTE was 35–45 years old in both with and without PCOS. This study determined characteristics of both patient groups with an increased risk of VTE. These include age (p < 0.0001), region (p < 0.0001), present of metabolic syndrome (p = 0.0002), obesity (p < 0.0001), pregnancy (p < 0.0001), diabetes (p < 0.0001), inherited thrombophilia (p < 0.0001), and oral contraceptive pill (OCP) use (p < 0.0001). Of the patients with PCOS, the relative odds of VTE were highest in the 18–24 years age range (adjusted odds ratio 3.26; 95% confidence interval 2.61–4.08). Interestingly, they also evaluated VTE prevalence with OCP use and found a protective effect (odds ratio 0.8; 95% confidence interval 0.73–0.97). A limitation for this study involves the inconsistencies of coding. As the data were derived from a claims database, codes were assigned mainly for billing and not for diagnoses. Physicians likely varied in their numbers and types of codes, leading to incomplete or inappropriate coding for the patient. [Jenny L. Chua-Tuan, MD, MBA Denver Health Medical Center, Denver, CO] Comment: Although this study does have its limitations, it is interesting to see a potential association between PCOS and VTE. As emergency physicians, we can use this information for a heightened awareness of this patient population while evaluating for VTE or when a patient presents with an unknown cause for VTE. , SURGICAL ADVERSE OUTCOMES IN PATIENTS WITH SCHIZOPHRENIA: A POPULATION-BASED STUDY. Liao CC, Shen WW, Chang CC, Chang H, Chen TL. Ann Surg 2013;257:433–8. This large-scale population-based and cross-sectional study from Taiwan identified 8967 surgical patients with schizophrenia out of a total 2,010,412 surgical patients and evaluated postoperative outcomes. Schizophrenic patients were found to have increased likelihood of other medical problems such as chronic obstructive pulmonary disease, diabetes, and stroke. Patients with schizophrenia were also found to have higher 30-day rates of postoperative complications such as stroke (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.18–1.64), pneumonia (OR 2.99, 95% CI 2.33–3.83), septicemia (OR 2.83; 95% CI 2.06–3.87), acute renal failure (OR 3.92; 95% CI 2.25–6.81), and postoperative bleeding (OR 1.27; 95% CI 1.05–1.54). They were also found to have higher postoperative mortality rates as surgical patients (OR 2.7; 95% CI 2.08–3.49) vs. those without mental disease. Overall, a nearly two-and-a-half-fold increase for postoperative complications and mortality rates were seen in schizophrenic surgical patients. One proposed cause for this discrepancy is human error. This theory suggests that patients with mental disease may be unaware of or inaccurately describe their symptoms, thus leading to a delay in diagnosis and subsequent treatment. Second, the medicine interactions between psychiatric medications, anesthetics, and analgesics may be inaccurately dosed for this patient population. Complaints from schizophrenic patients may also be interpreted as somatic and