In Reply.—Dr Schiffman makes a number of interesting points in his discussion of our recent article1 on thoracentesis complications. We agree that the complication rate is most likely dependent on a number of factors, including: the method used to perform the procedure, accessibility of the fluid, and level of expertise of the person performing the procedure. Our study was designed to examine one of these factors—namely, the method used by physicians in training to perform the procedure—while controlling for the other factors. Our results demonstrate that the method by which thoracentesis is performed by physicians in training does influence the frequency of complications. While it is not possible to make any definitive statements concerning the extent to which the other factors influence the complication rate, a few comments are appropriate.
In terms of accessibility of fluid, only those patients who could cooperate and who had free flowing fluid were