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 .
Ordering blood tests for patients with unexplained fatigue in general practice: what does it yield? Results of the VAMPIRE trial.
BACKGROUND Unexplained fatigue is frequently encountered in general practice . Because of the low prior probability of underlying somatic pathology , the positive predictive value of abnormal ( blood ) test results is limited in such patients . AIM The study objectives were to investigate the relationship between established diagnoses and the occurrence of abnormal blood test results among patients with unexplained fatigue ; to survey the effects of the postponement of test ordering on this relationship ; and to explore consultation-related determinants of abnormal test results . DESIGN OF STUDY Cluster r and omised trial . SETTING General practice s of 91 GPs in the Netherl and s. METHOD GPs were r and omised to immediate or postponed blood-test ordering .  Patients with new unexplained fatigue were included . Limited and exp and ed sets of blood tests were ordered either immediately or after 4 weeks . Diagnoses during the 1-year follow-up period were extracted from medical records . Two-by-two tables were generated . To establish independent determinants of abnormal test results , a multivariate logistic regression model was used . RESULTS Data of 325 patients were analysed ( 71 % women ; mean age 41 years ) . Eight per cent of patients had a somatic illness that was detectable by blood-test ordering . The number of false-positive test results increased in particular in the exp and ed test set . Patients rarely re-consulted after 4 weeks . Test postponement did not affect the distribution of patients over the two-by-two tables . No independent consultation-related determinants of abnormal test results were found . CONCLUSION Results support restricting the number of tests ordered because of the increased risk of false-positive test results from exp and ed test sets . Although the number of re-consulting patients was small , the data do not refute the advice to postpone blood-test ordering for medical reasons in patients with unexplained fatigue in general practice
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 .