Lithgow hit: Girl, 11, becomes third tragic victim of fatal five-vehicle car crash, a week after two men died in horror pile-up that left 12 others fighting for their lives

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The death toll from a horror multi-vehicle crash west of the NSW Blue Mountains has risen to three after a young girl died in hospital.

The girl was one of 15 people injured in a five-vehicle crash on the Great Western Highway at Wallerawang, 15 kilometers north of Lithgow, on December 30 that left two men dead.

An eastbound Isuzu D-max towing a motorcycle trailer collided with a westbound Toyota Hilux before the Toyota struck a Hyundai Tuscan, causing it to leave the roadway and trapping its occupants.

The Isuzu hit a Kia Carnival head-on and a caravan-pulling Nissan Patrol, which was driving behind the Isuzu, hit the trailer.

The Isuzu driver, a 42-year-old man, and the Kia driver, a 49-year-old man, were trapped and died at the scene.

Fire and Rescue NSW service commander Phil Vaiciurgis described the crash as 'a confronting scene of carnage' (pictured, paramedics with one of the injured)

The horror crash injured at least 15 people and killed two drivers, Mr McMahon and the 49-year-old male Kia driver (photo, emergency services on scene)

More than a dozen others were injured, including a 41-year-old woman and five children aged five to 15 in the Kia.

One of the passengers, an 11-year-old girl, had died at the children's hospital in Westmead, police confirmed on Saturday.

More than 80 rescue personnel, including police, paramedics, Fire and Rescue NSW, Rural Fire Service, VRA Rescue and the State Emergency Service, attended the scene.

The police will prepare a report for the coroner.

How the deadly crash unfolded

1. Jason McMahon and a family friend were driving east on the Great Western Highway at Wallerawang, near Lithgow, when his Isuzu D-Max collided with a westbound Toyota Hilux with four occupants.

2. The impact resulted in the Toyota Hilux hitting a Hyundai Tuscan, throwing it off the highway and trapping the three occupants, including a man aged 55, who was later flown to John Hunter Hospital in Newcastle

3. Mr McMahon's Isuzu D-Max then collided head-on with a Kia Carnival driven by David Drozd, whose wife and five children were injured and taken to hospital. Both Mr McMahon and Mr Drozd were trapped by the impact and died at the scene.

4. A Nissan Patrol, towing a caravan traveling behind Mr McMahon, then collided with the Isuzu trailer. Four occupants of the Nissan Patrol were examined at the scene

How the horror crash on the Great Western Highway claimed two lives and injured 15

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