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Factors influencing the diagnosis of chronic fatigue syndrome by primary health care professionals.
Solomon L, Reeves WC.Factors influencing the diagnosis of chronic fatigue syndrome by primary health care professionals
Archives of Internal Medicine 2004;164:2241-2245.
Summary
CFS is defined based on self reported symptoms and disability. As yet there are no definitive physical signs or laboratory abnormalities. Excellent studies by experienced clinical investigators have produced disparate and often conflicting results. This may in part reflect "recruitment bias" associated with studies conducted with patients attending tertiary care clinics. Indeed, most persons with CFS in the general population have not been diagnosed as such by a physician. This article describes the characteristics of people with CFS in the community who have and have not been diagnosed as or treated for CFS. With respect to bias in clinical research studies, almost half (41%) of people whose CFS began suddenly and only 6% of those with gradual onset CFS had been diagnosed and treated for CFS; those diagnosed and treated had significantly more symptoms and had been ill considerably longer than the others. We found that household income was the only demographic variable significantly associated with receiving medical care for CFS and somewhat surprisingly those in the middle-income group were more likely to have been diagnosed or treated than those in the high-income group. Although not statistically significant, women with CFS were more likely to be have been treated by a physician than were men with the illness, those older than 40 were more likely to be diagnosed/treated than younger individuals, and those with less than high school education were less likely than the more educated to have been diagnosed/treated. The study has important implications. Most importantly, people diagnosed as having CFS by their physicians are clearly not representative of the population with CFS, and many of the perceptions about CFS-within the scientific community and in the general public-are based on studies in which participants are not drawn from a community sample. To gain a true understanding of this complex illness, the entire population with CS, not just the small subset of persons who are diagnosed by a physician, must be studied.
Abstract
Background: Most of what is believed about chronic fatigue syndrome (CFS) is based on clinic-based studies. These studies may not reflect CFS cases in the population.
Methods: We used data from a population-based study of CFS to identify factors associated with receiving a CFS diagnosis. Residents of Wichita, Kansas, were screened by random-digit dialing for prolonged fatigue. Those reporting fatigue completed a detailed telephone interview and those meeting CFS criteria were invited for a clinical evaluation to confirm CFS. The present study involves all persons with confirmed CFS. Herein, we present an exploratory analysis with previous CFS diagnosis as the outcome, predicted by demographic and symptom characteristics.
Results: We confirmed CFS in 90 subjects; 14 (16%) had been previously diagnosed as having CFS. Persons in the middle- vs. the higher-income group were more likely to have been diagnosed as having CFS (9 [29%] of 31 subjects vs. 3 [8%] of 39 subjects; P = .03), as were those with sudden vs. gradual fatigue onset (7 [41%] of 17 subjects vs. 4 [6%] of 64 subjects; P<.01), those reporting tender lymph nodes (7 [33%] of 21 subjects vs. 7 [10%] of 69 subjects; P=.02). Only 17 (21%) of 81 subjects had sudden fatigue onset, and tender lymph nodes (reported in 21 [23%] of 90 subjects) and a sore throat (reported in 17 [19%] of 90 subjects) were the least common symptoms.
Conclusion: Most cases of CFS in the population are unrecognized by the medical community; persons diagnosed as having CFS may be different from persons with CFS in the general population.
Page last modified on May 8, 2006
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