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August 24/31, 2005

Surfactant and Pediatric Acute Lung Injury

JAMA. 2005;294(8):898-899. doi:10.1001/jama.294.8.898-b

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).