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 .
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 .
Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care.
BACKGROUND Chronic fatigue syndrome ( CFS ) has been defined , but many more patients consult in primary care with chronic fatigue that does not meet the criteria for CFS . General practitioners ( GPs ) do not generally use the CFS diagnosis , and have some doubt about the validity of CFS as an illness . AIM To describe the proportion of patients consulting their GP for fatigue that met the criteria for CFS , and to describe the social , psychological , and physical differences between patients with CFS and those with non-CFS chronic fatigue in primary care . DESIGN OF STUDY Baseline data from a trial of complex interventions for fatigue in primary care . SETTING Twenty-two general practice s located in London and the South Thames region of the United Kingdom recruited patients to the study between 1999 and 2001 . METHOD One hundred and forty-one patients who presented to their GP with unexplained fatigue lasting six months or more as a main symptom were recruited , and the Centers for Disease Control ( CDC ) case definition was applied to classify CFS . RESULTS Approximately two-thirds ( 69 % ) of patients had chronic fatigue  and not CFS . The duration of fatigue ( 32 months ) and perceived control over fatigue were similar between groups ; however , fatigue , functioning , associated symptoms , and psychological distress were more severe in the patients in the CFS group , who also consulted their GP significantly more frequently , were twice as likely to be depressed , and more than twice as likely to be unemployed . About half ( CFS = 50 % ; chronic fatigue = 55 % ) in each group attributed their fatigue to mainly psychological causes . CONCLUSIONS In primary care , CFS is a more severe illness than chronic fatigue , but non-CFS chronic fatigue is associated with significant fatigue and is reported at least twice as often . That half of patients , irrespective of CFS status , attribute their fatigue to psychological causes , more than is observed in secondary care , indicates an openness to the psychological therapies provided in that setting . More evidence on the natural history of chronic fatigue and CFS in primary care is required , as are trials of complex interventions . The results may help determine the usefulness of differentiating between chronic fatigue and CFS
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 .
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 .