WASHINGTON - Surviving major trauma - a car crash, gunshot wounds, burns - isn't just a matter of fixing the obvious injuries. About a week into the healing, many patients' organs suddenly fail, as doctors watch helplessly.
They can't predict who will go into this downward spiral, or how victims will fare. Numerous attempts at treatments have failed.
Now a huge federal research program is under way to determine why one patient dies while another with equally severe injuries lives. And the first good clues suggest that traumatic injury can literally change people's genes in a way that makes their immune systems run amok, harming their own organs.
If the finding holds up, in gene tests in emergency rooms around the country, it could do more than help doctors tell in advance which of their patients is most likely to live. Organ failure causes about a quarter of the nation's 160,000 trauma-related deaths each year, and the ultimate goal is to finally find a way to treat or even prevent it.
"Right now, almost all the therapies in the ICU are supportive. The patient's basically dependent on fixing themselves," said Dr. Paul Bankey, trauma chief at the University of Rochester Medical Center.
"Whether they're going to ultimately make it or not boils down to whether they acquire organ failure."
Trauma is the leading killer of Americans younger than 45, mostly because of car crashes, and the nation's No. 5 killer overall.
People with injuries that once were invariably fatal today have hope of surviving thanks to increasingly skilled first-responders and advances in emergency-room care.
But once the injuries themselves are stabilized - doctors have done all they can and sent the patient to the intensive care unit to heal - progress hits a wall. Survival hasn't improved much in a decade, and doctors realized it was because how the body overreacts to an injury can cause even more damage than the initial trauma.