Background Adult emergency department mortality remains high in resource-limited lower-income countries. The majority of deaths occur within the first 24 h of presentation to the emergency department. Many of these mortality’s can be alleviated with appropriate interventions. This study was aimed to assess the magnitude, cause, and factors related to very early mortality in patients presented to the emergency department of Tikur Anbesa Specialized Tertiary Hospital, Ethiopia from March 2018 to 2020. Methods This is a cross-sectional retrospective chart review. Retrospective data were collected from the records of all patients who died within 72 h of emergency department presentation from March 2018 to 2020. Data entered using Epi data 4.2.1 and analyzed using SPSS Version 23. Using the Chi-square test, binary and multiple logistic regression analysis were carried out to measure the association of variables of interest and very early emergency mortality. P-value < 0.05, odds ratio with 95% CI were used to identify the significant factors. Results Between March 2018 to 2020, 30,086 patients visited the ED and 604 patients died within 72 h of presentation (274 died within 24 h and 232 within > 24–72 h). Shock (36.7%) and road traffic accidents (3.16%) were the major causes of death. Triage category red AOR 0.23 95% CI 0.1–0.55 and duration of illness 4–24 h AOR 0.47 95% CI 0.26–0.87 were significantly associated with decreased very early emergency department mortality. Meanwhile, co-morbid disease HIV AIDS AOR 2.72 95% CI 1.01–7.30 and residence Addis Ababa AOR 2.78 95% CI 1.36–5.68 and Oromia AOR 3.23 95% CI 1.58–6.54 were found significantly associated with increased very early emergency department mortality. Conclusions and recommendations The mortality burden of a road traffic accident and shock in the TASTH is significant and the magnitude of ED mortality differs between these groups. Residence Addis Ababa and Oromia, triage category red, co-morbid disease HIV AIDS, and duration of symptom 4–24 h were significantly associated with early emergency department mortality. Early detection and intervention are required to minimize emergency mortality.

Background: Adult emergency department mortality remains high in resource-limited lower-income countries. The majority of deaths occur within the first 72 hours of admission to the emergency department which is termed as early emergency department mortality. Many of these mortality’s can be alleviated with appropriate intervention. Though the magnitude, cause, and the time interval of death after their admission to the department have a huge aspect for the clinical world, however, studies on this topic lack adequate data. Therefore, this study was aimed to assess the magnitude, cause, and factors related to early mortality in patients presented to the emergency department of Tikure Anbesa Specialized Tertiary Hospital, Ethiopia from March 2018 to 2020. Methods: A retrospective cross-sectional study design was conducted to address the study objectives. Retrospective data were collected from the patients’ records who died in the emergency department from March 2018 to 2020. Data entered using Epi data 4.2.1 and analyzed using SPSS Version 23. Using the Chi-square test, binary and multiple logistic regression analyses were carried out to measure the association of variables of interest and the outcome variable (early emergency mortality). P-value < 0.05, odds ratio with 95% CI were used to identify the significant factors. Results: From the total identified emergency department death records, 506 (59.8) were early mortality. Triage category red AOR 0.23 95% CI 0.1-0.55, co-morbid disease HIV AIDS AOR 2.72 95% CI 1.01-7.30, residence Addis Ababa 2.78 (1.36-5.68) and Oromia 3.23 95% CI 1.58-6.54 and duration of illness 4-24 hour AOR 0.47 95% CI 0.26-0.87 were found significantly associated with early emergency department mortality. Conclusions and recommendations: The magnitude of early mortality was significant. Residence Addis Ababa and Oromia, triage category red, co-morbid disease HIV AIDS, and duration of symptom 4-24 hours were significantly associated with early emergency department mortality. Early detection and intervention are required to minimize emergency mortality.