Alternative diagnoses to chronic fatigue syndrome in referrals to a specialist service: service evaluation survey

OBJECTIVE To assess the accuracy of diagnoses made by referrers to a chronic fatigue syndrome (CFS) service. DESIGN Retrospective service evaluation surveys of both rejected referral letters and medical case-notes after full clinical assessment. SETTING A specialist CFS clinic in London, UK. PARTICIPANTS In the first survey, we assessed rejected referral letters between March 2007 and September 2008. In the second survey, we ascertained the primary diagnosis made in case-notes of 250 consecutive new patients assessed between April 2007 and November 2008. MAIN OUTCOME MEASURES Reasons for rejection of referrals and primary diagnosis in those assessed. RESULTS In the first survey, 154 out of 418 referrals (37%) were rejected. Of these, 77 out of the available 127 referrals (61%) had a likely alternative diagnosis. In the second survey of clinically assessed patients, 107 (43%) had alternative medical/psychiatric diagnoses, while 137 out of 250 (54%) patients received a diagnosis of CFS. The commonest alternative medical diagnoses of those assessed were sleep disorders and the commonest alternative psychiatric diagnosis was depressive illness. Altogether 184 of 377 (49%) patients had alternative diagnoses to CFS. CONCLUSIONS Half of all the referred patients to a specialist CFS clinic had alternative medical and psychiatric diagnoses. Specialist medical assessment for patients with unexplained, disabling, chronic fatigue needs to incorporate both medical and psychiatric assessments.