CMAJ • November 10, 2009; 181 (10). First published October 26, 2009; doi:10.1503/cmaj.090647
© 2009 Canadian Medical Association or its licensors
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Research

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 and Henriëtte van der Horst, MD PhD

From the Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center (Nijrolder, van der Windt, de Vries, van der Horst), Amsterdam, the Netherlands; and the Arthritis Research Campaign National Primary Care Centre, Keele University (van der Windt), Keele, United Kingdom

Correspondence to: Iris Nijrolder, Netherlands Institute for Health Services Research, PO Box 1568, Utrecht 3500 BN, the Netherlands; i.nijrolder{at}nivel.nl

Background: Little is known about the distribution of diagnoses that account for fatigue in patients in primary care. We evaluated the diagnoses established within 1 year after presentation with fatigue in primary care that were possibly associated with the fatigue.

Methods: We conducted a prospective observational cohort study with 1-year follow-up. We included adult patients who presented with a new episode of fatigue between June 2004 and January 2006. We extracted data on diagnoses during the follow-up period from the patients’ medical records as well as data on pre-existing chronic diseases.

Results: Of the 571 patients for whom diagnostic data were available, 268 (46.9%) had received one or more diagnoses that could be associated with fatigue. The diagnoses were diverse and mostly included symptom diagnoses, with main categories being musculoskeletal (19.4%) and psychological problems (16.5%). Clear somatic pathology was diagnosed in 47 (8.2%) of the patients. Most diagnoses were not made during the consultation when fatigue was presented.

Interpretation: Only a minority of patients were diagnosed with serious pathology. Half of the patients did not receive any diagnosis that could explain their fatigue. Nevertheless, 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.


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Can. Med. Assoc. J. 2009 181: 657. [Full Text] [PDF]



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Fatigue and general practitioners
Thomas Frese
CMAJ, 3 Nov 2009 [Full text]
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Ian D Connell
CMAJ, 12 Nov 2009 [Full text]