In 1993 the British Thoracic Society (BTS) recommended simple chest aspiration rather than insertion of an intercostal drain in the initial management of spontaneous pneumothorax. An audit of patients with pneumothorax admitted to our hospital before these recommendations were published showed that only two of 19 were initially treated by chest aspiration whereas 14 had a chest drain inserted. In the year after the new guidelines, 13 of 14 patients admitted had initial chest aspiration, and drains were inserted only when aspiration was unsuccessful. This audit shows that contrary to popular belief it is possible to change clinical practice radically in a short time.
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