Diagnoses of fatigue in primary care patients

Patients who visit their family doctors for fatigue have a wide range of diagnoses yet the prevalence of serious illness was low, according to a Dutch study (pre-embargo link only)http://www.cmaj.ca/embargo/cmaj090647.pdf in CMAJ (Canadian Medical Association Journal) www.cmaj.ca. Fatigue is a common problem seen in 5% to 10% of patients, and its non-specific nature makes it challenging for general practitioners. The study sought to describe the diagnoses associated with fatigue established within 1 year after presentation.

It looked at 571 patients in 147 general practices across the Netherlands who presented with fatigue as a main symptom. Forty-seven per cent of patients received one or more diagnoses that could be associated with fatigue, with musculoskeletal problems the most common at 19.4%. Other diagnoses included diseases or problems of the digestive tract (8.1%), nervous system (6.7%) and respiratory tract (4.9%). Of the 8.2% of patients diagnosed with severe illness, these illnesses included anemia, lung pathology, thyroid dysfunction, diabetes, heart disease, cancer and others. Half the patients did not receive a diagnosis that explained their fatigue.

"Because most symptoms may show a recurrent pattern over time, further research is needed to help clarify the association between fatigue and other non-specific symptoms," write Iris Nijrolder of the VU Medical Center in Amsterdam and coauthors.

However, psychological problems were the second largest diagnosis and may actually be underestimated. Depressive symptoms were noted more frequently in self-reported patient questionnaires than in patients' medical charts. Sleep problems were also underreported in patient charts.

A study limitation was that the researchers did not use standardized protocols for physical examinations and diagnostic testing, which would have resulted in variations in the recorded diagnoses.

"Because of the wide range of conditions and symptoms that may explain or co-occur with the fatigue, fatigue is a complex problem that deserves attention not only as a symptom of underlying specific disease," conclude the researchers.

Source: Canadian Medical Association Journal