In Reply.—We agree with Dr Esposito that a hospital of similar size and location as ours, with level 2 resources and a systematic approach to trauma care, can and should achieve results comparable with those of a level 1, urban hospital. Our study was designed to establish that fact with the most objective means available. Although it may not have been strictly correct to refer to the MTOS as representing level 1 urban trauma centers, it is generally accepted that the MTOS standards represent state-of-the-art results for comparisons of trauma care. Dr Esposito may automatically accept our hospital as a "peer" of those included in the MTOS, but small, rural hospitals such as ours that might meet the resource criteria for inclusion in the development of trauma systems also need to be able to document the quality of their results. We believe our experience is relevant since at the
DIETZ PA, BROOKS K. What Is the Meaning of Labels on Trauma Care?-Reply. Arch Surg. 1992;127(8):995. doi:10.1001/archsurg.1992.01420080128027
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