Gallstone ileus. / Gallesteinsileus.

Gallstones are common, but rarely cause ileus. This case report illustrates the clinical course of a patient who developed gallstone ileus without any previously identified gallstone symptoms.

Improvement in geriatric trauma outcomes in an evolving trauma system.

BACKGROUND: The elderly trauma patient has increased mortality compared with younger patients. During the last 15 years, initial treatment of severely injured patients at Oslo University Hospital Ulleval (OUHU) has changed resulting in overall improved outcomes. Whether this holds true for the elderly trauma population needs exploration and was the aim of the present study. METHODS: We performed a retrospective study of 2628 trauma patients 61 years or older admitted to OUHU during the 12-year period, 2002-2013. The population was stratified based on age (61-70 years, 71-80 years, 81 years and older) and divided into time periods: 2002-2009 (P1) and 2010-2013 (P2). Multiple logistic regression models were constructed to identify clinically relevant core variables correlated with mortality and trauma team activation rate. RESULTS: Crude mortality decreased from 19% in P1 to 13% in P2 (p<0.01) with an OR of 0.77 (95 %CI 0.65 to 0.91) when admitted in P2. Trauma team activation rates increased from 53% in P1 to 72% in P2 (p<0.01) with an OR of 2.16 (95% CI 1.93 to 2.41) for being met by a trauma team in P2. Mortality increased from 10% in the age group 61-70 years to 26% in the group above 80 years. Trauma team activation rates decreased from 71% in the age group 61-70 years to 50% in the age group older than 80 years. Median ISS were 17 in all three age groups and in both time periods. DISCUSSION: Development of a multidisciplinary dedicated trauma service is associated with increased trauma team activation rate as well as survival in geriatric trauma patients. As expected, mortality increased with age, although inversely related to the likelihood of being met by a trauma team. Trauma team activation should be considered for all trauma patients older than 70 years. LEVEL OF EVIDENCE: Level IV.