To the Editor.
—In their study of the influence of patient ethnicity on emergency department administration of analgesia, Todd et al1 examined the potential influence of 17 other predictor variables (Table 2). Included among these were patient insurance status, occupation, and arrival time, as well as the ethnicity and gender of the treating physician. Conspicuous by its absence from the variables examined, however, is perhaps the single most important determinant of whether an individual patient in the emergency department ought to receive analgesia: his or her level of pain and distress as gauged by health providers. This would have been described in physicians' and nurses' notes and could have been reported and used to shed light on those questions of "cultural influences on the expression of pain" appropriately raised by the authors in the concluding paragraphs of the article. Is it the case that those study patients who received
Mariani PJ. Ethnicity and Emergency Department Analgesia. JAMA. 1993;270(7):831. doi:10.1001/jama.1993.03510070053030