Timbol Christian R, Baraniuk James N
Division of Rheumatology, Immunology and Allergy, Georgetown University, Washington, DC, USA,
Open Access Emerg Med. 2019 Jan 11;11:15-28. doi: 10.2147/OAEM.S176843. eCollection 2019.
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.
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.
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.
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.
慢性疲劳综合征（CFS）是一种使人衰弱的疾病，其特征为疲劳、运动后不适、认知功能障碍、睡眠障碍及全身疼痛。一项初步的在线调查旨在确定CFS患者在急诊科（ED）的常见症状表现以及他们对就医经历的看法。
创建匿名调查问卷，用于评估CFS核心症状的严重程度、前往急诊科的原因，并用李克特量表对护理态度和印象进行评分。对开放文本字段进行定性分类，以确定就医经历的常见主题。
在282名经医生诊断为CFS的受访者中，59%曾前往急诊科就诊。三分之一的急诊科就诊情况与直立不耐受相符；42%的参与者被诊断为心身疾病而遭拒诊。急诊科工作人员对CFS了解不足。就医体验不佳（10分制中得3.6分）。其余41%的受试者未前往急诊科，称无能为力或不会被认真对待。CFS患者可通过CFS问卷以及持续存在（>6个月）的持续性疲劳、认知、睡眠和运动后不适问题来识别。
这是首次对CFS患者在急诊科的表现进行调查，表明直立不耐受作为最常见的急性就诊原因的重要性。自我报告的CFS问卷可能作为急诊科的筛查工具。有必要对急诊科工作人员进行CFS现代概念的教育，以提高患者和工作人员的满意度。针对这些具有挑战性的就医情况，为CFS的诊断和治疗提供了指导。
