Diagnosis Of Fatigue Is Complex

Editor's Choice
Main Category: Primary Care / General Practice
Also Included In: Depression;  Medical Devices / Diagnostics
Article Date: 27 Oct 2009 - 0:00 PDT

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A Dutch study published in the Canadian Medical Association Journal (CMAJ) reports that patients who consult with their family doctors for fatigue have a wide range of diagnoses, however the incidence of serious illness is low.

Fatigue, because of its non-specific nature is challenging for general practitioners. It is a common problem occurring in 5 to 10 percent of patients. The study aimed to describe the diagnoses associated with fatigue established within one year after presentation.

The study involved a total of 571 patients in 147 general practices across the Netherlands. They all presented with fatigue as a main symptom. Overall, 47 percent of patients received one or more diagnoses that could be associated with fatigue. Musculoskeletal problems were the most common with 19.4 percent. Other diagnoses included diseases or problems of the digestive tract (8.1 percent), nervous system (6.7 percent) and respiratory tract (4.9 percent). 8.2 percent of patients were diagnosed with severe illness including: anemia, lung pathology, thyroid dysfunction, diabetes, heart disease, cancer and others. Half the patients did not receive a diagnosis that explained their fatigue.

Iris Nijrolder of the VU Medical Center in Amsterdam and coauthors write: "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."

Interestingly, psychological problems were the second largest diagnosis and may in fact be underestimated. Depressive symptoms were noted more often in self-reported patient questionnaires than in patients' medical charts. In addition, sleep problems were also underreported in patient charts.

The study had limitations because the researchers did not use uniform protocols for physical examinations and diagnostic testing. This could have resulted in differences in the recorded diagnoses.

The researchers write in conclusion: "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."

"Diagnoses during follow-up of patients presenting with fatigue in primary care" Iris Nijrolder MSc, Daniëlle van der Windt PhD, Henk de Vries MD PhD, Henriëtte van der Horst MD PhD
CMAJ 2009.DOI:10.1503/cmaj.090647
Canadian Medical Association Journal

Written by Stephanie Brunner (B.A.)
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