DEFICIENCIES OF MANAGEMENT OF SPONTANEOUS PNEUMOTHORACES

In a retrospective. case-note based, audit of the initial management o f spontaneous pneumothoraces in a large teaching hospital, 38 events w ere identified in 37 patients admitted over 12 months to the end of Se ptember 1991. The initial management was intercostal tube drainage in 21 (55%), decided upon by middle grade staff, with a cost in terms of the duration of hospitalisation (median 7 (range 2-18) days), chest ra diography (6 (3-10) films) and potential for complications including i nfections (3 wound, 2 chest). Aspiration was performed in only three c ases. the remainder were managed by observation. We suggest that undue reliance is placed upon intercostal tube drainage to treat spontaneou s pneumothoraces with aspiration alone performed too infrequently. Mor eover, other deficiencies in management including the practise of drai n clamping and incomplete follow-up were identified.