{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T22:32:48Z","timestamp":1790029968871,"version":"4.0.1"},"reference-count":20,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2026,2,23]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the patterns, severity, and in-hospital mortality of trauma at Khyber Teaching Hospital (KTH), Peshawar, during 5 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort (2018\u20132022) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 10 542 patients (mean age 32\u00b119 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&lt;0.001) and more severe traumatic brain injury (56% vs 18%; p&lt;0.001). Independent predictors of death were age &gt;60 years (OR 4.3; 95% CI 3.5 to 5.4), ISS &gt;25 (OR 5.6; 4.5\u20136.9), systolic BP &lt;90\u2009mm Hg (OR 4.9; 3.9\u20136.2), and GCS Score &lt;8 (OR 6.1; 4.9\u20137.7). RTS and Trauma and Injury Severity Score showed strong discrimination (Area under the curve (AUC)=0.90).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2025-001890","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T15:25:42Z","timestamp":1784215542000},"page":"e001890","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of trauma-related mortality in Peshawar, Pakistan: a study at Khyber Teaching Hospital"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5004-223X","authenticated-orcid":false,"given":"Rafi","family":"Ullah","sequence":"first","affiliation":[{"name":"Khyber Medical College, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laiba","family":"Ali","sequence":"additional","affiliation":[{"name":"Khyber Medical College, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farooq","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Khyber Medical College, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubna","family":"Kashif","sequence":"additional","affiliation":[{"name":"Khyber Medical College, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asif","family":"Khan","sequence":"additional","affiliation":[{"name":"Hayatabad Medical Complex, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faheem","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Radiology, Khyber Teaching Hospital Peshawar, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irfan","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Khyber Teaching Hospital Peshawar, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Khan","sequence":"additional","affiliation":[{"name":"Hayatabad Medical Complex, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Hayatabad Medical Complex, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6218-0500","authenticated-orcid":false,"given":"Asraf","family":"Hussain","sequence":"additional","affiliation":[{"name":"Chitwan Medical College, Bhadrapur, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adil","family":"Rehman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"2026071608251950000_11.3.e001890.1","unstructured":"World Health Organization . Injuries and violence [fact sheet]. Geneva WHO; 2024. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/injuries-and-violence"},{"key":"2026071608251950000_11.3.e001890.2","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/j.puhe.2012.12.020","article-title":"The challenges of injuries and trauma in Pakistan: an opportunity for concerted action","volume":"127","author":"Hyder","year":"2013","journal-title":"Public Health (Fairfax)"},{"key":"2026071608251950000_11.3.e001890.3","doi-asserted-by":"crossref","DOI":"10.1016\/j.amsu.2021.103137","article-title":"A pilot trauma registry in Peshawar, Pakistan - A roadmap to decreasing the burden of injury - Quality improvement study","volume":"72","author":"Tanoli","year":"2021","journal-title":"Ann Med Surg (Lond)"},{"key":"2026071608251950000_11.3.e001890.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-012-1459-6"},{"key":"2026071608251950000_11.3.e001890.5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.29252\/beat-080105","article-title":"A Comparative Study of Injury Severity Scales as Predictors of Mortality in Trauma Patients: Which Scale Is the Best?","volume":"8","author":"Yadollahi","year":"2020","journal-title":"Bull Emerg Trauma"},{"key":"2026071608251950000_11.3.e001890.6","doi-asserted-by":"crossref","first-page":"933","DOI":"10.29309\/TPMJ\/2022.29.07.6270","article-title":"Presentation of trauma patients in a tertiary care hospital in Pakistan","volume":"29","author":"Mushtaq","year":"2022","journal-title":"TPMJ"},{"key":"2026071608251950000_11.3.e001890.7","article-title":"Epidemiology of Penetrating Chest Injuries Presenting at a Tertiary Care Center in Peshawar: A Retrospective Study","volume":"16","author":"Baseer","year":"2024","journal-title":"Cureus"},{"key":"2026071608251950000_11.3.e001890.8","doi-asserted-by":"crossref","unstructured":"Khan F , Shah A , Janan AA . Burn patients: causes of death and factors affecting mortality \u2013 a 4 years study at a tertiary care hospital. Prof Med J 2013;20. doi:10.29309\/TPMJ\/2013.20.06.1826","DOI":"10.29309\/TPMJ\/2013.20.06.1826"},{"key":"2026071608251950000_11.3.e001890.9","doi-asserted-by":"crossref","first-page":"317","DOI":"10.53350\/pjmhs20221612317","article-title":"Pediatric Traumatic Brain Injury; Experience in Tertiary Care Hospitals of KPK, A Multi- Center Study","volume":"16","author":"Khan","year":"2023","journal-title":"Pak J Med Health Sci"},{"key":"2026071608251950000_11.3.e001890.10","unstructured":"Hassan N , Ali M , Haq NU , Azam F , Khan S , Khan Z , et al . Etiology, clinical presentation and outcome of traumatic brain injury patients in a teaching hospital of Khyber Pakhtunkhwa. 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Injury: a neglected global health challenge in low- and middle-income countries. 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