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Portada del sitio > Documentos > Estudios Científicos > Unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME)is (...)

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 · 876 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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