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* From Children’s Hospital, San Diego, CA.
Correspondence to: Carolyn E. Behrendt, PhD, 4065 3413 Paseo del Campo, Palos Verdes, CA 90274; e-mail: CarolynBehrendt{at}yahoo.com
Study objectives: To estimate the incidence of acute respiratory failure (ARF) in the United States and to analyze 31-day hospital mortality among a cohort of patients with ARF.
Design and setting: Retrospective cohort drawn from the Nationwide Inpatient Sample of 6.4 million discharges from 904 representative nonfederal hospitals during 1994.
Patients: All 61,223 patients in the sample whose discharge
records indicated all of the following: acute respiratory distress or
failure, mechanical ventilation, 
24 h of hospitalization, and age
5 years.
Results: An estimated 329,766 patients
discharged from nonfederal hospitals nationwide in 1994 met study
criteria for ARF. The incidence of ARF was 137.1 hospitalizations per
100,000 US residents age 5 years. Incidence increased
nearly exponentially each decade until age 85 years. Overall, 35.9% of
patients with ARF did not survive to hospital discharge. At 31 days,
hospital mortality was 31.4%. According to the proportional hazards
model, significant mortality hazards included age ( 80 years and
30 years), multiorgan system failure (MOSF), HIV, chronic liver
disease, and cancer. Hospital admission for coronary artery bypass,
drug overdose, or trauma other than head injury or burns was associated
with a reduced mortality hazard. Interaction was present between age
and MOSF, trauma, and cancer. A point system derived from the hazard
model classified patients into seven groups with distinct 31-day
survival probabilities ranging from 24 to 99%.
Conclusions: The incidence of ARF increases markedly with
age and is especially high among persons 65 years of age.
Nonpulmonary hazards explain short-term (31-day)
survival.
Key Words: acute disease • adult • aged • child • hospital mortality • incidence • respiratory insufficiency • survival analysis • United States
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