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To the Editor: In their article on the use of an exogenous surfactant (calfactant), Dr Willson and colleagues¹ concluded that calfactant " . . . significantly decreased mortality in infants, children, and adolescents with [acute lung injury] ALI. . . . " Although the study demonstrated reduced mortality in the overall study population, the conclusion implies that calfactant was effective in decreasing mortality in each of the 3 age groups. Randomization was not stratified by age. Neither sufficient information on the population age distribution nor age-specific study results were shown to support the inference that each age group benefited from calfactant. Although a logistic regression analysis demonstrated that calfactant was still associated with a decrease in mortality after controlling for possible confounding by age, this does not exclude the possibility that the effect of calfactant on mortality is modified by age (ie, statistical interaction).

We still do not know if calfactant decreases mortality in older children and adolescents . . . [Full Text of this Article]

Elizabeth A. Hunt, MD, MPH
ehunt@jhmi.edu

Jamie McElrath Schwartz, MD; James C. Fackler, MD
Department of Anesthesiology and Critical Care Medicine
Johns Hopkins School of Medicine
Baltimore, Md

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