|
The authors analyzed the CCEP database of 21,579 participants
in the evaluation program for findings pertaining to diagnoses that fell
into the ICD-9 category of "Signs, Symptoms, and Ill-Defined Conditions
(SSID)." This category includes "symptoms, signs, abnormal results
of laboratory or other investigative procedures, and ill-defined conditions
regarding which no diagnosis classifiable elsewhere is recorded."
SSID diagnoses were categorized as 1) those with objective findings (such
as sleep apnea, sleep disorder due to periodic limb movements, seizure
disorders, rash, weight loss, positive TB skin test, and test abnormalities)
and 2) those that are symptoms only (patient complaints for which there
is neither objective confirmation nor an explanatory diagnosis). 17.2
% of all CCEP participants had their primary (main) diagnosis within the
SSID category and 41.8 % had an SSID diagnosis as either their primary
or secondary diagnosis. 28.6% of primary SSID were objective abnormalities
but most SSID were symptoms. Patients with SSID diagnoses were comparable
to other CCEP participants with regard to age, race, gender, self-reported
wartime exposures, length of stay in the combat theater, and days of work
missed in the previous 3 months. Patients with an SSID primary diagnosis
after Phase I of the CCEP were twice as likely to be referred to a Phase
II evaluation at a medical center. Two thirds (464) of the referred 703
Phase I SSID patients had a non-SSID primary diagnosis after Phase II.
The final diagnoses for 45% of these 464 were psychological, chiefly mood
disorders, somatoform disorders, tension headache, and posttraumatic stress
disorder. As the depth of evaluation increased, the proportion of diagnoses
that were SSID decreased but the proportion of psychological diagnoses
increased. The three most common symptom diagnoses were fatigue, headache,
and memory loss. For patients with these primary diagnoses in Phase I
who completed a Phase II evaluation, most did not retain the same primary
diagnoses. Limitations of the study: CCEP participants are self-selected
and are not necessarily representative of all Gulf War veterans. Self-reported
information, such as wartime exposures, may be subject to recall bias.
There is likely variation in practice and interpretation of clinical data
from one medical facility to another. The study does not prove that there
is not a new illness or syndrome.
|
