In Reply.—Dr Sukoff's ill-tempered letter has appeared elsewhere on several occasions and has been answered by us, but there is apparently no stopping somebody with an obsession. The chief points in rebuttal are as follows.
(1) Dr Sukoff seems unable to distinguish between factors contributing to the prevalence of vehicular trauma (eg, freeway usage) and factors contributing to the outcome of the injuries (system of care).
(2) Geographic differences between the two counties are important in planning the location of trauma centers, as discussed in detail in our report. They do not, however, prevent comparisons of patients who are alive on arrival to the emergency room. (His concern with the difference in climate between Orange and San Francisco counties continues to baffle me.)
(3) The series of patients described includes several non-CNS deaths (33% in Orange County and 17% in San Francisco County). Our conclusions regarding these nonneurosurgical patients