Chronisch Vermoeidheidssyndroom: diagnose, behandeling en ...

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28 Chronic Fatigue Syndrome KCE reports 88 Study Country Dobbins, 1997 60 Haines, 2005 61 Chalder, 2003 62 Farmer, 2004 63 Jones, 2004 64 Rimes, 2007 65 N, response rate (%) Ascertainment Setting CDC-1988 CDC-1994 Australian British No valid definition USA Primary care point prevalence 0.0027% 17 years) lifetime (12- UK N = 718 GP GP report Primary care prevalence 0.062% practices 70% (0.059-0.069) UK N = 10 438 Self report Community 0.19% (5-15 Self-report: CDC definition years) 0.57% Parental report (0.06–0.32) (0.34–0.80) point Parental prevalence report: 0.038% (0.00–0.076) South Wales N = 1 468 Parents report Community fatigue > 3 and Greater 65% months Manchester 1.90% (8-17 (UK) years) Wichita, Community (1.40–2.40) fatigue > 6 months 1.29% (0.87-1.71) lifetime prevalence 0.338% (12-17 Kansas (USA) years) point prevalence UK N = 842 Validated Community 0.1% (11-15 77% instruments years) Non clinical (0.0 – 0.4). interviewers
KCE Reports 88 Chronic Fatigue Syndrome 29 2.4.3 Prevalence: discussion Epidemiological studies and their estimates differ according to the setting in which they were conducted (e.g. community, primary care, tertiary care); the age of population considered, the definition or criteria used for diagnosis; the instruments used to define CFS and to exclude other medical and/or psychiatric conditions, more or less specific and sensitive; the method of ascertainment (e.g. self-report, parent report, physician report, chart review); the time course of ascertainment (e.g. retrospective, prospective); the sampling method (e.g. random, consecutive, referred, volunteers) and the response rate of the population that is studied. 66 In general, more restrictive definitions of CFS, excluding psychiatric or other medical diagnoses and requiring longer duration of fatigue lead to lower prevalence estimates compared to less restrictive definitions. For example, use of the 1988 CDC criteria, which are the most stringent, appeared associated with the lowest prevalence estimates. Moreover, community populations have lower prevalence estimates than primary care or hospital populations. 66 Evidence suggests a population prevalence of at least 0.2-2.5%. Such a prevalence means that a general practice with a population of 10 000 patients is likely to have between 20 and 250 patients with CFS. It is important to underline that the higher prevalence estimated in Georgia reflects a difference in screening criteria. This survey screened for unwell (the core symptoms of CFS) whereas previous studies have only screened for fatigue. 55 This less restrictive approach allowed the inclusion of potential CFS cases omitted with the more exclusive criteria “fatigue”. The 6- to 10-fold greater prevalence estimates also reflect application of more sensitive and specific measures of the CFS diagnostic parameters specified by the 1994 case definition. Previous surveys did not use validated standardized instruments to define CFS but queried as to the presence or absence of fatigue, accompanying symptoms, and impairment. Following the recommendations published by the International Chronic Fatigue Syndrome Study Group, Reeves et al. (2007) 55 used validated instruments to obtain standardized measures of the major symptom domains of the illness: 1) the SF-36, to measure functional impairment; 2) the Checklist Individual Strength or MFI, to obtain reproducible quantifiable measures of fatigue; 3) and the CDC Symptom Inventory to document the occurrence, duration and severity of the symptom complex. This results in detecting about 3 times the number of CFS cases as verbatim application of the 1994 definition. Prevalence estimates also differ according to the period of evaluation: point prevalence, 4-year period prevalence or lifetime prevalence. Because of the long duration of CFS, the period prevalence estimates can be more appropriately compared with the point prevalence estimates. 52 For adolescent patients (>10 years), prevalence estimates range between 0.0027% and 0.338%. Such estimates mean that a general practice with a population of 10 000 adolescent patients is likely to have between 1 and 34 patients with CFS. For younger patients (5-15 years), prevalence estimates are 0.1% in community, indicating that 10 patients would have the CFS diagnosis in a 10 000 children population. 2.4.4 Incidence of CFS in adults There are few studies having estimated the incidence of CFS. Their results are summarized in Table 2. Lawrie et al. 67 estimated that the annual incidence of CFS was 370 per 100 000, but their sample was non-random and relatively small. During a 4-year surveillance period in four US metropolitan areas, Reyes et al. (1997) 52 identified 19 incident cases. The overall annual incidence rates, as well as the sitespecific annual incidence rates, were less than one case per 100 000 persons. Reyes et al. (2003) 54 conducted a prevalence study in Wichita (0.23%) completed by a 1year follow-up telephone interview and clinical examination to estimate the incidence of
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