Abstract
BackgroundTiredness is one of the most frequent complaints in primary care. Although often self-limiting and frequently associated with psychosocial stress, patients but also their physicians are often uncertain regarding a serious cause and appropriate diagnostic work-up. We conducted a systematic review and meta-analysis of studies reporting on differential diagnosis of fatigue in primary care.MethodsMEDLINE, EMBASE and conference abstracts were searched for primary care based studies of patients presenting with tiredness. Twenty-six studies were included. We report on anaemia, malignancy, serious organic disease, depression and the chronic fatigue syndrome (CFS) as causes of tiredness as presenting complaint.ResultsWe found considerable heterogeneity of estimates which was reduced by limiting our analysis to high quality studies. Prevalences were as follows-anaemia: 2.8 % (CI (confidence interval) 1.6–4.8 %); malignancy: 0.6 % (CI 0.3–1.3 %); serious somatic disease: 4.3 % (CI 2.7–6.7 %); depression 18.5 % (CI 16.2–21.0 %). Pooling was not appropriate for CFS.In studies with control groups of patients without the symptom of tiredness, prevalence of somatic disease was identical to those complaining of tiredness. Depression, however, was more frequent among those with tiredness.ConclusionsSerious somatic disease is rare in patients complaining of tiredness. Since prevalence is similar in patients without tiredness, the association may not be causal. Extensive investigations are only warranted in case of specific findings from the history or clinical examination. Instead, attention should focus on depression and psychosocial problems.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0545-5) contains supplementary material, which is available to authorized users.
Highlights
Tiredness is one of the most frequent complaints in primary care
We excluded 20 studies in which patients were systematically asked about tiredness, the remaining 26 studies investigating tiredness as a reason for encounter or secondary complaint form the sample of our review
Tiredness in primary care: underlying diseases We present results for the following etiological categories: anaemia, malignancies, serious somatic diseases, depression and chronic fatigue syndrome (CFS) (Fig. 2)
Summary
Tiredness is one of the most frequent complaints in primary care. often self-limiting and frequently associated with psychosocial stress, patients and their physicians are often uncertain regarding a serious cause and appropriate diagnostic work-up. Tiredness is usually self-limiting and explained by obvious circumstances, but sometimes it occurs in the context of defined somatic diseases, such as anaemia or hypothyroidism, or of mental disorder, such as Primary care practitioners, who are usually the first health professionals to be contacted for tiredness, must decide on the kind and extent of diagnostic measures to take. This is fraught with uncertainty since serious disease may occur, but is rare and often untypical. For a rational work-up of these patients, knowledge of disease probabilities is an essential first step
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