Chronic fatigue syndrome in the emergency department

Abstract

PurposeChronic fatigue syndrome (CFS) is a debilitating disease characterized by fatigue, postexertional malaise, cognitive dysfunction, sleep disturbances, and widespread pain. A pilot, online survey was used to determine the common presentations of CFS patients in the emergency department (ED) and attitudes about their encounters.MethodsThe anonymous survey was created to score the severity of core CFS symptoms, reasons for going to the ED, and Likert scales to grade attitudes and impressions of care. Open text fields were qualitatively categorized to determine common themes about encounters.ResultsFifty-nine percent of respondents with physician-diagnosed CFS (total n=282) had gone to an ED. One-third of ED presentations were consistent with orthostatic intolerance; 42% of participants were dismissed as having psychosomatic complaints. ED staff were not knowledgeable about CFS. Encounters were unfavorable (3.6 on 10-point scale). The remaining 41% of subjects did not go to ED, stating nothing could be done or they would not be taken seriously. CFS subjects can be identified by a CFS questionnaire and the prolonged presence (>6 months) of unremitting fatigue, cognitive, sleep, and postexertional malaise problems.ConclusionThis is the first investigation of the presentation of CFS in the ED and indicates the importance of orthostatic intolerance as the most frequent acute cause for a visit. The self-report CFS questionnaire may be useful as a screening instrument in the ED. Education of ED staff about modern concepts of CFS is necessary to improve patient and staff satisfaction. Guidance is provided for the diagnosis and treatment of CFS in these challenging encounters.

Comparison of three frailty measures for 90‐day outcomes of elderly patients undergoing elective abdominal surgery

“…A score of ≤0.25 is considered robust, a score of 0.25–0.4 is considered pre‐frail and a score of >0.4 is considered frail. The third method is the CFS, which had been used in a large number of studies on the CFS and prognosis of patients in emergency departments and ICUs in the past 2 years 9,12 . The CFS has nine levels separated into three categories: levels 1–3 are considered robust, level 4 is considered pre‐frail and levels 5–9 are considered frail.…”

“…The third method is the CFS, which had been used in a large number of studies on the CFS and prognosis of patients in emergency departments and ICUs in the past 2 years. 9,12 The CFS has nine levels separated into three categories: levels 1-3 are considered robust, level 4 is considered pre-frail and levels 5-9 are considered frail. Forty-eight hours prior to surgery, the FRAIL, FI and CFS were assessed.…”

Medical Care Situation of People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in Germany

“…Furthermore, 71% of participants saw four or more physicians in order to receive a diagnosis. Whereas participants who saw a specialist reported being satisfied with medical care, the satisfaction with care from non-specialists (e.g., GPs, staff of emergency departments) was reported to be low [ 20 , 24 , 25 ]. Timbol and Baraniuk [ 25 ] investigated the satisfaction with medical care in the emergency department (ED) in a sample of 282 patients with physician-diagnosed ME/CFS.…”

“…Whereas participants who saw a specialist reported being satisfied with medical care, the satisfaction with care from non-specialists (e.g., GPs, staff of emergency departments) was reported to be low [ 20 , 24 , 25 ]. Timbol and Baraniuk [ 25 ] investigated the satisfaction with medical care in the emergency department (ED) in a sample of 282 patients with physician-diagnosed ME/CFS. Fifty-nine percent of patients reported having visited an ED in the past, predominantly due to orthostatic intolerance.…”

“…Fifty-nine percent of patients reported having visited an ED in the past, predominantly due to orthostatic intolerance. Patients were dissatisfied with ED care in that they indicated that the staff were not knowledgeable about ME/CFS and half of the staff attributed patients’ complaints to stress, anxiety or psychological issues [ 25 ]. Other studies also showed that patients attributed their dissatisfaction with medical care to the inadequate training of physicians in treatment of patients with their illness [ 20 , 24 ].…”