Adolescent Chronic Fatigue Syndrome: Prevalence, Incidence and Morbidity – Pediatrics, 18 April 2011

From Pediatrics, official journal of the American Academy of Pediatrics, 18 April 2011.

Adolescent Chronic Fatigue Syndrome: Prevalence, Incidence, and Morbidity

Sanne L. Nijhof, MD(a), Kimberley Maijer, MD(a), Gijs Bleijenberg, PhD(b), Cuno S. P. M. Uiterwaal, MD, PhD(c), Jan L. L. Kimpen, MD, PhD(a), Elise M. van de Putte, MD, PhD(a)

(a)Department of Pediatrics, Wilhelmina Children's Hospital, and
(c)Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands, and
(b)Expert Centre Chronic Fatigue, Radboud University, Nijmegen Medical Centre, Netherlands

OBJECTIVE To determine nationwide general practitioner (GP)-diagnosed prevalence and pediatrician–diagnosed incidence rates of adolescent chronic fatigue syndrome (CFS), and to assess CFS morbidity.

DESIGN AND SETTING We collected data from a cross-sectional national sample among GPs and prospective registration of new patients with CFS in all pediatric hospital departments in the Netherlands.

PATIENTS AND METHODS Study participants were adolescents aged 10 to 18 years. A representative sample of GPs completed questionnaires on the prevalence of CFS in their adolescent patients. Pediatric hospital departments prospectively reported new cases of CFS in adolescent patients. For every new reported case, a questionnaire was sent to the reporting pediatrician and the reported patient to assess CFS morbidity. Prevalence was estimated through the data from GP questionnaires and incidence was estimated on the basis of cases newly reported by pediatricians from January to December 2008.

RESULTS Prevalence was calculated as 111 per 100 000 adolescents and incidence as 12 per 100 000 adolescents per year. Of newly reported patients with CFS, 91% scored at or above cutoff points for severe fatigue and 93% at or above the cutoff points for physical impairment. Forty-five percent of patients with CFS reported >50% school absence during the previous 6 months.

CONCLUSIONS Clinically diagnosed incidence and prevalence rates show that adolescent CFS is uncommon compared with chronic fatigue. The primary adverse impact of CFS is extreme disability associated with considerable school absence.

Key Words: chronic fatigue • adolescents • epidemiology • incidence • prevalence

Abbreviations: CFS = chronic fatigue syndrome • CDC = Centers for Disease Control and Prevention • GP = general practitioner • NIVEL = Dutch Institute for Research of Health Services • DPSU = Dutch Pediatric Surveillance Unit • CIS-20 = Checklist Individual Strength

Accepted Jan 27, 2011.