Chronic fatigue syndrome in the emergency department

Abstract

Purpose:

Chronic 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.

Methods:

The 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.

Results:

Fifty-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.

Conclusion:

This 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.

Keywords::

• patient satisfaction
• orthostatic intolerance
• postexertional malaise
• myalgic encephalomyelitis
• systemic exertion intolerance disease
• SEID

Ethics, consent, and permissions

Human participants completed an online questionnaire in an anonymous fashion. No personal information was obtained. Subjects approved of the informed consent in order to participate in the study. The study was approved by the Georgetown University Institutional Review Board and conformed to the Declaration of Helsinki.

Data sharing statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Acknowledgments

Ms Amber Surian, MS, provided editorial and other support. Funding was provided by The Sergeant Sullivan Circle, Dr. Barbara Cottone, the Dean Clarke Bridge Prize, and the National Institute of Neurological Diseases and Stroke (RO1NS085131). The design of the study and collection, analysis, and interpretation of data and writing of the manuscript were independent of all funders.

Author contributions

CRT conceived of the study, obtained IRB approval, created the questionnaires, conducted the program, performed data analysis, and wrote the draft manuscript while a student at the Georgetown University School of Medicine. JNB provided mentorship and edited the final paper. Both authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.