Evaluation of trauma-related mortality in Peshawar, Pakistan: a study at Khyber Teaching Hospital

Trauma is a leading cause of death and disability in low-income and middle-income countries. In Pakistan, limited reporting and absence of trauma registries restrict understanding of outcomes in Peshawar.

To describe the patterns, severity, and in-hospital mortality of trauma at Khyber Teaching Hospital (KTH), Peshawar, during 5 years.

This retrospective cohort (2018-2022) included all trauma admissions at KTH. Data on demographics, mechanism, Injury Severity Score (ISS), Revised Trauma Score (RTS), and Glasgow Coma Scale (GCS) Score were extracted. Logistic regression identified predictors of in-hospital death; annual trends were analyzed.

Among 10 542 patients (mean age 32±19 years; 72% male), blunt trauma comprised 58%, penetrating injuries 23%, and burns 8%. Road traffic accidents (RTAs) caused half of all injuries, followed by falls (16%), and violence (15%). Overall mortality was 9.4% (n=995), decreasing from 10.8% in 2018 to 8.7% in 2022. Fatalities had higher median ISS (25 vs 9; p<0.001) and more severe traumatic brain injury (56% vs 18%; p<0.001). Independent predictors of death were age >60 years (OR 4.3; 95% CI 3.5 to 5.4), ISS >25 (OR 5.6; 4.5-6.9), systolic BP <90 mm Hg (OR 4.9; 3.9-6.2), and GCS Score <8 (OR 6.1; 4.9-7.7). RTS and Trauma and Injury Severity Score showed strong discrimination (Area under the curve (AUC)=0.90).

Trauma mainly from RTAs remains a major cause of in-hospital death at KTH despite modest decline. High ISS, hypotension, and low GCS Score were strongest mortality predictors. Strengthened prehospital care, dedicated trauma centers, and a provincial registry are key to reducing preventable deaths in Khyber Pakhtunkhwa.