Background: The classification of ED mortality is important because it identifies a group of patients who can benefit from the treatment that are provided at the department. Early mortality is defined as death within 72 hrs.‟ of ED presentation (7) and 'very early' ED mortality is defined as death within 24 hours (8). This 'very early' mortality group represents the most urgently ill patients likely to benefit from ED care interventions to prevent mortality. Objective: The purpose of this is study to assess clinical profile and magnitude of early emergency department mortality among patients presented to the adult emergency department of Tikur Anbesa Specialized Hospital from March 1,2018-March 1, 2020, Addis Ababa, Ethiopia. Methodology: A cross-sectional study design was used to assess clinical profile and Magnitude of early mortality in the adult emergency department, Tikur Anbesa Specialized Hospital; Addis Ababa, Ethiopia, From March 1, 2018 to March 1, 2020. The data were collected by review of patients‟ medical record cards. Data was entered by Epi data 4.2.1 and analyzed by SPSS Version 23. Binary and multiple logistic regression analysis were used for the association. Statically significance was P-value<0.05 at CI 95%. Result: Of analyzed 506 charts, overall early ED mortality rate was 1.68 %, with male to female ratio 1.1:1. From multiple logistic regression results, it was found that, patients who were triaged as Green were 4.2 times more likely to die after 24 hrs of admission.‟ than patients who triaged as red. (AOR= .235 95% CI .101, .546). Patients who presented with chief compliant of >1 week duration were 2.1 times more likely to die after 24 hrs of admission.‟ than who came with chief complaints of 4-24 hrs.‟ duration (AOR = .471, 95% CI: (.256, .866.). From co morbid diseases HIV patients were 2.7 times more likely to die after 24 hrs.‟ than Asthmatic patients.‟ (AOR = 2.720, 95% CI: (1.013, 7.300). Conclusion and recommendations: even though important steps were done to boost the emergency care there are still gaps. It has been found triage acuity; comorbid disease and duration of symptoms of patients were associated with Early ED mortality. Therefore it is essential to improve the quality of care of ED, to reduce the magnitude of preventable ED mortalities.