OBJECTIVE: To develop an evidence-based systematic approach to
assessment of adult patients who present to family physicians
complaining of fatigue of less than 6 months’ duration. The
guidelines present investigative options, making explicit what
should be considered in all cases and what should be
considered only in specific situations. They aim to provide
physicians with an approach that, to the extent possible, is
based on evidence so that time and cost are minimized and
detection and management of the cause of the fatigue are
QUALITY OF EVIDENCE: MEDLINE was searched from 1966
to 1997 using the key words family practice and fatigue.
Articles about chronic fatigue syndrome were excluded.
Articles with level 3 evidence were found, but no randomized
trials, cohort studies, or case-control studies were found.
Articles looking specifically at the epidemiology,
demographics, investigations, and diagnoses of patients with
fatigue were chosen. Articles based on studies at referral and
specialty centres were given less weight than those based on
studies in family physicians’ offices.
MAIN MESSAGE: Adherence
to these guidelines will decrease the cost of investigating
the symptom of fatigue and optimize diagnosis and management.
This needs to be proved in practice, however, and with
research that produces level 1 and 2 evidence.
Adults presenting with fatigue of less than 6 months’ duration
should be assessed for psychosocial causes and should have a
focused history and physical examination to determine whether
further investigations should be done. The guidelines outline
investigations to be considered. The elderly require special
consideration. These guidelines have group validation, but
they need to be tested by more physicians in various locations
and types of practices.
Godwin M, Delva D, Miller K, Molson J, Hobbs N, MacDonald S, MacLeod