LAUSR

W e thankDr. Elkbuli et al. for their interest and stimulating questionswith regards to our article “A preliminary analysis of Level IV trauma centers within an organized trauma system.” A first point of clarification with regards to their letter is that the level IV hospitals in Pennsylvania were not accredited by the American College of Surgeons but rather by the Pennsylvania State Trauma Foundation, an independent governing agency of the Pennsylvania Trauma System that has been in place since the mid-1980s. The Pennsylvania State Trauma Foundation has as its governing principle that it will accept the accrediting policies and procedures of the American College of Surgeons optimal care document with the addition of supplementary policies and procedures specific to the Pennsylvania Trauma