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Oligoanalgesia is the term that denotes under-use of analgesia with painful conditions.  A study was carried out to assess the risks of patients receiving inadequate analgesia in emergency rooms in several hospitals in a large North American city.  Two hospitals were unwilling to participate and so data were obtained from only 6.  Records were reviewed for a 2 year period and all patients who received treatment for fracture of the long bones (humerus, radius, ulna, femoral shaft, tibia and fibula) were included.  Information was gathered about the type of analgesic used (non-narcotic, narcotic) and the route of administration (oral, parenteral).  With respect to dosage, two categories were used, low or high (less than or equivalent to 10 mg of parenteral morphine sulphate).

The proportion of patients receiving inappropriate analgesia in each of those places is tabulated below.  The location of each of these hospitals is indicated on the map.

Emergency Room Oligoanalgesia (% of treated patients)
A 56%
B 49%
C 51%
D 12%
E 19%
F 15%


This problem was based on two papers suggesting that ethnicity was a risk factor for oligoanalgesia is in the emergency rooms of an American city (Annals Emergency Medicine 35:11, 2000, JAMA 269: 1537, 1993). The students were shown a non-descript map with the hospitals in different locations. Three of the hospitals were clustered close to the city centre and the others were spread out. Again many different explanations were possible and the students became quite imaginative.

These included public versus private hospitals, differences in competencies, different formularies, variations in numbers, sampling errors, larger volume of patients in inner city hospitals, ethnicity etc. Once explanations were given, it was not difficult for the students to define the ways and means they would use to gather more information. The open-endedness of the exercise permitted students to explore a variety of options.

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