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Crawley EM, Emond AM, Sterne JAC. BMJ Open 2011;1:e000252. doi:10.1136/bmjopen-2011-000252

Unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME)is a major cause of school absence: surveillance outcomes from school-based clinics

Miércoles 14 de diciembre de 2011 · 793 lecturas

Unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME)is a major cause of school absence: surveillance outcomes from
school-based clinics
Esther M Crawley,1 Alan M Emond,1 Jonathan A C Sterne2
ABSTRACT
Objective: To investigate the feasibility of conducting
clinics for chronic fatigue syndrome/myalgic
encephalomyelitis (CFS/ME) in schools.
Design: School-based clinical project.
Participants: Children aged 11e16 years were
enrolled in three state secondary schools in England.
Main outcome measures: Number of children newly
diagnosed as having CFS/ME.
Methods: Attendance officers identified children
missing $20% of school in a 6-week term without
a known cause, excluding those with a single episode
off school, a known medical illness explaining the
absence or known to be truanting. Children with
fatigue were referred to a specialist CFS/ME service for
further assessment. The authors compared children
with CFS/ME identified through school-based clinics
with those referred via health services. Outcomes of
CFS/ME were evaluated at 6 weeks and 6 months.
Results: 461 of the 2855 enrolled children had missed
$20% school over a 6-week period. In 315, of whom
three had CFS/ME, the reason for absence was known.
112 of the 146 children with unexplained absence
attended clinical review at school; two had been
previously diagnosed as having CFS/ME and 42 were
referred on to a specialist clinic, where 23 were newly
diagnosed as having CFS/ME. Therefore, 28 of the
2855 (1.0%) children had CFS/ME. Children with CFS/
ME identified through surveillance had been ill for an
amount of time comparable to those referred via health
services but had less fatigue (mean difference 4.4,
95% CI 2.2 to 6.6), less disability (mean difference

  • 5.7, 95% CI -7.9 to -3.5) and fewer symptoms
    (mean difference 1.86, 95% CI 0.8 to 2.93). Of 19
    children followed up, six had fully recovered at
    6 weeks and a further six at 6 months.
    Conclusions: Chronic fatigue is an important cause
    of unexplained absence from school. Children
    diagnosed through school-based clinics are less
    severely affected than those referred to specialist
    services and appear to make rapid progress when they
    access treatment.

Article focus

  • Hypothesis: many children with CFS/ME remain
    undiagnosed and untreated, despite evidence
    that treatment is effective in children.
  • Research question: are school-based clinics
    a feasible way to identify children with CFS/ME
    and offer treatment?
    Key messages
  • 1.0% of enrolled children missed $20% of
    school because of CFS/ME.
  • Fewer than one in five children with CFS/ME had
    received a diagnosis and been offered treatment.
  • Children with CFS/ME who were detected
    through school-based clinics were less severely
    affected than children referred via health services
    and appeared to do well once treated.
    Strengths and limitations of this study
  • Children were offered assessment regardless of
    how their absence had been classified.
  • All children given a diagnosis of CFS/ME were
    screened for other medical and emotional causes
    of fatigue and were prospectively characterised
    and followed up.
  • School clinics were conducted in three schools in
    the south west, which has a well-established
    specialist CFS/ME service. Results may not be
    generalisable to regions without a CFS/ME
    service or to regions with different socioeconomic
    factors that impact on school attendance.

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