Background: This study aims to assess the frequency of mortality in patients with severe adult tetanus who present with pre-defined poor prognostic indicators. To date, no research has been conducted on this population in our region, making the findings of this study crucial for informing future research and improving management strategies for severe tetanus cases. The results will be shared with healthcare providers, including public health professionals, to highlight current mortality statistics and advocate for more comprehensive management and prevention efforts for patients with severe tetanus. To evaluate the in-hospital mortality rate among adult patients with severe tetanus who present with poor prognostic factors. Methodology: A descriptive cross-sectional study was conducted at the Department of Emergency Medicine, Lady Reading Hospital, Peshawar from November 12, 2023, to May 12, 2024. A total of 176 patients aged 18 to 60 years with severe tetanus and poor prognostic indicators were included in the study. All patients received management according to established protocols, and in-hospital mortality was recorded. Data were analyzed using SPSS version 25. Results Conclusion The study included 176 participants, with ages ranging from 18 to 60 years. The mean age was 38.54 ± 10.82 years, and the mean body mass index (BMI) was 24.08 ± 1.73 kg/m². In-hospital mortality was observed in 64 patients (36.4%). Severe tetanus patients presenting with poor prognostic signs remain at high risk of in-hospital mortality, underscoring the need for heightened clinical awareness and aggressive management strategies.