The differential diagnosis of tiredness: a systematic review

BMC Family Practice

Research Article

Stefan Bösner¹  Erika Baum¹  Annika Viniol¹  Norbert Donner-Banzhoff¹  Jörg Haasenritter¹  Rebekka Stadje¹  Katharina Dornieden¹  Tobias Biroga¹  Annette Becker¹  Christian Keunecke¹ 

[1] Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany;

关键词: Tiredness;    Fatigue;    Primary care;    Meta-analysis;   

DOI  :  10.1186/s12875-016-0545-5

 received in 2015-12-12, accepted in 2016-10-18,  发布年份 2016

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2016