Introduction: In low income countries, Road Traffic Accident (RTA) Death remains high. This describes that RTA are a major public health challenge. And also, the problem is increasing from time to time in resource-limited countries. The most economically active age groups (18-50) are at the greatest risk of dying as a result of RTA. This affects economically, social and political stability of the countries. Therefore, this study aimed to describe the pattern of RTA death and associated factors in the adult emergency department. Methods: A two-year retrospective chart review of RTA injury was conducted at ALERT Hospital. The data were collected by using a structured checklist. Descriptive statistic like frequencies, percentage, means, standard division, and proportion was computed for selected variables using SPSS version 21. Logistic regression was used to predict the measure of association between interest independent variables and death due to RTA injuries. Result: - The proportion rate of RTA death was 27(17.4%) from 155 of RTA injury patients presented Adult Emergency Department of ALERT Hospital. This result translates to a mortality rate of RTA was 34.8 deaths per 1000 patients per year. Multivariate analysis indicated that individuals who drank alcohol while driving were three times more likely to be died in RTA as compared to those who didn’t drink alcohol. And also, victims who had more year of experience in driving been less likely or reduced by a 65% chance of died in RTA than their counter parts. Conclusion: The prevalence of RTA death was high in this study. Use of alcohol while driving and year of experience in driving was most significant associated with road traffic accident-related death. To alleviate these problems awareness creation and measuring blood alcohol content levels and breathe analyzers for the driver during driving is more recommended.