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The course of newly presented unexplained complaints in general practice patients: a prospective cohort study
Family Practice, 10/14/09

Koch H et al. – One year after initial presentation, a large proportion of newly presented UCs remained unexplained and unresolved. The authors identified determinants that GPs might want to consider in the early detection of patients at risk of UC persistence and/or low QoL.

Methods

Prospective cohort study in general practice of patients presenting with a new unexplained complaints (UCs).
Data sources were case record forms, patient questionnaires and electronic medical registries at inclusion, 1, 6 and 12 months.
Presence of complaints and diagnoses made over time were documented.
Potential risk factors were assessed in mixed–effect logistic and linear regression models.

Results

63 GPs included 444 patients (73% women; median age 42) with unexplained fatigue (70%), abdominal complaints (14%) and musculoskeletal complaints (16%).
At 12 months, 43% of the patients suffered from their initial complaints.
57 % of the UCs remained unexplained.
UCs had (non–life–threatening) somatic origins in 18% of the patients.
QoL was often poor at presentation and tended to remain poor.
Being a male and GPs’ being more certain about the absence of serious disease were the strongest predictors of a diminished probability that the complaints would still be present and unexplained after 12 months.
The strongest determinants of complaint persistence [regardless of (un)explicability] were duration of complaints >4 weeks before presentation, musculoskeletal complaint at baseline, while the passage of time acted positively.
Musculoskeletal complaints, compared to fatigue, decreased QoL on the physical domain, while presence of psychosocial factors decreased mental QoL.