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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Koch, Hèlen Van Bokhoven, Marloes A. Ter Riet, Gerben Van Alphen-jager, Jm Tineke Van Der Weijden, Trudy Dinant, Geert-Jan Bindels, Patrick J. E. |
| Spatial Coverage | Netherlands |
| Description | Country affiliation: Netherlands Author Affiliation: Koch H ( Academic Medical Center-University of Amsterdam, Division of Clinical Methods and Public Health, Department of General Practice, Amsterdam, the Netherlands. h.koch@amc.uva.nl) |
| Abstract | 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 randomised trial. SETTING: General practices of 91 GPs in the Netherlands. METHOD: GPs were randomised to immediate or postponed blood-test ordering. Patients with new unexplained fatigue were included. Limited and expanded 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 expanded 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 expanded 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. |
| File Format | HTM / HTML |
| ISSN | 09601643 |
| e-ISSN | 14785242 |
| DOI | 10.3399/bjgp09X420310 |
| Journal | British Journal of General Practice |
| Issue Number | 561 |
| Volume Number | 59 |
| Language | English |
| Publisher | Royal College of General Practitioners |
| Publisher Date | 2009-04-01 |
| Publisher Place | Great Britain (UK) |
| Access Restriction | Open |
| Subject Keyword | Research Support, Non-u.s. Gov't Sensitivity And Specificity Discipline Family Medicine False Negative Reactions Fatigue Unnecessary Procedures Hematologic Tests Predictive Value Of Tests Randomized Controlled Trial Epidemiology Blood Netherlands Utilization Etiology Multicenter Study Statistics & Numerical Data Cluster Analysis |
| Content Type | Text |
| Resource Type | Article |
| Subject | Family Practice |
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