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. 2016 Oct 20;17(1):147.
doi: 10.1186/s12875-016-0545-5.

The differential diagnosis of tiredness: a systematic review

Rebekka Stadje  1 , Katharina Dornieden  2 , Erika Baum  2 , Annette Becker  2 , Tobias Biroga  2 , Stefan Bösner  2 , Jörg Haasenritter  2 , Christian Keunecke  2 , Annika Viniol  2 , Norbert Donner-Banzhoff  2
Affiliations

The differential diagnosis of tiredness: a systematic review

Rebekka Stadje et al. BMC Fam Pract. .

Abstract

Background: Tiredness 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.

Methods: MEDLINE, 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.

Results: We 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.

Conclusions: Serious 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.

Keywords: Fatigue; Meta-analysis; Primary care; Tiredness.

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Figures

Fig. 1
Fig. 1
Flow of search
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Fig. 2
Quantitative analysis of prevalence rates of anaemia, malignancies, severe somatic diseases and depression among patients presenting with fatigue in primary care of selected studies
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Fig. 3
Forest plot, frequencies of anaemia and quantitative analysis
Fig. 4
Fig. 4
Forest plots, frequencies of severe somatic diseases and quantitative analysis
Fig. 5
Fig. 5
Forest plots, frequencies of depressions and quantitative analysis
See this image and copyright information in PMC

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