Journal of the Royal Society of Medicine short report, 2012 Jan;3(1):4. Epub 2012 Jan 12.
Alternative diagnoses to chronic fatigue syndrome in referrals to a specialist service: service evaluation survey.
Devasahayam A, Lawn T, Murphy M, White PD.
NHS Greater Glasgow and Clyde, Yorkhill Hospital, Glasgow, UK.
OBJECTIVE: To assess the accuracy of diagnoses made by referrers to a chronic fatigue syndrome (CFS) service.
DESIGN: Retrospective service evaluation surveys of both rejected referral letters and medical case-notes after full clinical assessment.
SETTING: A specialist CFS clinic in London, UK.
PARTICIPANTS: In the first survey, we assessed rejected referral letters between March 2007 and September 2008. In the second survey, we ascertained the primary diagnosis made in case-notes of 250 consecutive new patients assessed between April 2007 and November 2008.
MAIN OUTCOME MEASURES: Reasons for rejection of referrals and primary diagnosis in those assessed.
RESULTS: In the first survey, 154 out of 418 referrals (37%) were rejected. Of these, 77 out of the available 127 referrals (61%) had a likely alternative diagnosis. In the second survey of clinically assessed patients, 107 (43%) had alternative medical/psychiatric diagnoses, while 137 out of 250 (54%) patients received a diagnosis of CFS. The commonest alternative medical diagnoses of those assessed were sleep disorders and the commonest alternative psychiatric diagnosis was depressive illness. Altogether 184 of 377 (49%) patients had alternative diagnoses to CFS.
CONCLUSIONS: Half of all the referred patients to a specialist CFS clinic had alternative medical and psychiatric diagnoses. Specialist medical assessment for patients with unexplained, disabling, chronic fatigue needs to incorporate both medical and psychiatric assessments.
PMID: 22299071 [PubMed – in process]