A Constructive Debate With the CDC on the Empirical Case Definition of Chronic Fatigue Syndrome (original) (raw)
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Evaluating the Centers for Disease Control's Empirical Chronic Fatigue Syndrome Case Definition
2008
The Centers for Disease Control and Prevention (CDC) recently developed an empirical case definition that specifies criteria and instruments to diagnose chronic fatigue syndrome (CFS) in order to bring more methodological rigor to the current CFS case definition. The present study investigated this new definition with 27 participants with a diagnosis of CFS and 37 participants with a diagnosis of a Major Depressive Disorder. Participants completed questionnaires measuring disability, fatigue, and symptoms. Findings indicated that 38% of those with a diagnosis of a Major Depressive Disorder were misclassified as having CFS using the new CDC definition. Given the CDC's stature and respect in the scientific world, this new definition might be widely used by investigators and clinicians. This might result in the erroneous inclusion of people with primary psychiatric conditions in CFS samples, with detrimental consequences for the interpretation of epidemiologic, etiologic, and treatment efficacy findings for people with CFS.
Sensitivity and Specificity of the CDC Empirical Chronic Fatigue Syndrome Case Definition
Psychology, 2010
In an effort to bring more standardization to the chronic fatigue syndrome (CFS) Fukuda et al. case definition [1], the Centers for Disease Control and Prevention (CDC) has developed an empirical case definition [2] that specifies criteria and instruments to diagnose CFS. The present study investigated the sensitivity and specificity of this CFS empirical case definition with diagnosed individuals with CFS from a community based study that were compared to non-CFS cases. All participants completed questionnaires measuring disability (Medical Outcome Survey Short-Form-36) [3], fatigue (the Multidimensional Fatigue Inventory) [4], and symptoms (CDC Symptom Inventory) [5]. Findings of the present study indicated sensitivity and specificity problems with the CDC empirical CFS case definition.
A population-based study of the clinical course of chronic fatigue syndrome
Health and quality of life outcomes, 2003
Chronic fatigue syndrome (CFS) presents a challenge for patients, health care providers, and health insurance groups because of its incapacitating nature, unknown cause, and poorly understood prognosis. We conducted a longitudinal population-based study to characterize the clinical course of CFS. Sixty-five CFS subjects were identified from a random-digit-dialing survey of Wichita, Kansas residents and followed for up to 3 years. We evaluated changes in CFS classification (partial or total remission, alternative medical or psychiatric diagnoses), CFS case-defining criteria, wellness scores, hours of activities and sleep, and treatments used to reduce fatigue. Associations between risk factors and outcomes were determined by use of logistic regression and generalized estimating equations models. Only 20%-33% of the subjects were classified as having CFS at follow-up, 56.9% ever experienced partial or total remission, 10% sustained total remission, and 23.1% received alternative diagn...
CDC Grand Rounds: Chronic Fatigue Syndrome - Advancing Research and Clinical Education
MMWR. Morbidity and mortality weekly report, 2016
Chronic fatigue syndrome (CFS) is a complex and serious illness that is often misunderstood. Experts have noted that the terminology "chronic fatigue syndrome" can trivialize this illness and stigmatize persons who experience its symptoms (1). The name was coined by a group of clinicians convened by CDC in the late 1980s to develop a research case definition for the illness, which, at the time, was called chronic Epstein-Barr virus syndrome. The name CFS was suggested because of the characteristic persistent fatigue experienced by all those affected and the evidence that acute or reactivated Epstein-Barr virus infection was not associated with many cases (2). However, the fatigue in this illness is striking and quite distinct from the common fatigue everyone experiences. A variety of other names have been used, including myalgic encephalomyelitis (ME), ME/CFS, chronic fatigue immune dysfunction, and most recently, systemic exertion intolerance disease (3). The lack of agre...
Nevada Chronic Fatigue Syndrome Consensus Conference
Journal Of Chronic Fatigue Syndrome, 2001
Chronic fatigue syndrome (CFS), a debilitating disorder of unknown etiology, has been the subject of a growing body of literature as information accumulates on the epidemiology, pathogenesis, and disease The authors are the members of the Nevada Consensus Panel.
Population Health Metrics, 2016
Background: Multiple case definitions are in use to identify chronic fatigue syndrome (CFS). Even when using the same definition, methods used to apply definitional criteria may affect results. The Centers for Disease Control and Prevention (CDC) conducted two population-based studies estimating CFS prevalence using the 1994 case definition; one relied on direct questions for criteria of fatigue, functional impairment and symptoms (1997 Wichita; Method 1), and the other used subscale score thresholds of standardized questionnaires for criteria (2004 Georgia; Method 2). Compared to previous reports the 2004 CFS prevalence estimate was higher, raising questions about whether changes in the method of operationalizing affected this and illness characteristics. Methods: The follow-up of the Georgia cohort allowed direct comparison of both methods of applying the 1994 case definition. Of 1961 participants (53 % of eligible) who completed the detailed telephone interview, 919 (47 %) were eligible for and 751 (81 %) underwent clinical evaluation including medical/psychiatric evaluations. Data from the 499 individuals with complete data and without exclusionary conditions was available for this analysis. Results: A total of 86 participants were classified as CFS by one or both methods; 44 cases identified by both methods, 15 only identified by Method 1, and 27 only identified by Method 2 (Kappa 0.63; 95 % confidence interval [CI]: 0.53, 0.73 and concordance 91.59 %). The CFS group identified by both methods were more fatigued, had worse functioning, and more symptoms than those identified by only one method. Moderate to severe depression was noted in only one individual who was classified as CFS by both methods. When comparing the CFS groups identified by only one method, those only identified by Method 2 were either similar to or more severely affected in fatigue, function, and symptoms than those only identified by Method 1. Conclusions: The two methods demonstrated substantial concordance. While Method 2 classified more participants as CFS, there was no indication that they were less severely ill or more depressed. The classification differences do not fully explain the prevalence increase noted in the 2004 Georgia study. Use of standardized instruments for the major CFS domains provides advantages for disease stratification and comparing CFS patients to other illnesses.
An examination of the working case definition of chronic fatigue syndrome
The American Journal of Medicine, 1996
PURPOSE: Chronic fatigue syndrome (CFS) currently is defined by a working case definition developed under the leadership of the United States Centers for Disease Control and Prevention (CDC) based on a consensus among experienced clinicians. We analyzed the experience from one large center to examine the adequacy of the case definition.
Prevalence and Incidence of Chronic Fatigue Syndrome in Wichita, Kansas
Archives of Internal Medicine, 2003
Background: Chronic fatigue syndrome (CFS) is a debilitating illness with no known cause or effective therapy. Population-based epidemiologic data on CFS prevalence and incidence are critical to put CFS in a realistic context for public health officials and others responsible for allocating resources and for practicing physicians when examining and caring for patients. Methods: We conducted a random digit-dialing survey and clinical examination to estimate the prevalence of CFS in the general population of Wichita, Kan, and a 1-year follow-up telephone interview and clinical examination to estimate the incidence of CFS. The survey included 33 997 households representing 90 316 residents. This report focuses on 7162 respondents aged 18 to 69 years. Fatigued (n=3528) and randomly selected nonfatigued (n=3634) respondents completed telephone questionnaires concerning fatigue, other symptoms, and medical history. The clinical examination included the Diagnostic Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, laboratory testing, and a physical examination. Results: The overall weighted point prevalence of CFS, adjusted for nonresponse, was 235 per 100000 persons (95% confidence interval, 142-327 per 100000 persons). The prevalence of CFS was higher among women, 373 per 100000 persons (95% confidence interval, 210-536 per 100000 persons), than among men, 83 per 100000 persons (95% confidence interval, 15-150 per 100 000 persons). Among subjects nonfatigued and fatigued for less than 6 months, the 1-year incidence of CFS was 180 per 100 000 persons (95% confidence interval, 0-466 per 100000 persons). Conclusions: Chronic fatigue syndrome constitutes a major public health problem. Longitudinal follow-up of this cohort will be used to further evaluate the natural history of this illness.