BackgroundIn Ethiopia, the first three days (72 hours) following admission to the emergency room account for more than half (59.8%) of all deaths. However, little is known about the prevalence of early mortality and its associated factors in Southern Ethiopia. ObjectiveThe main objective of this study is to assess the prevalence and associated factors of early mortality among deaths in adult emergency departments at selected public hospitals in Hawassa, southern Ethiopia. MethodsAn institutional-based retrospective cross-sectional study design was applied. A systematic random sampling technique was used to select 369 charts of patients who died in the adult emergency departments of selected public hospitals in the past two years. The data was collected using a standardized and pre-tested data abstraction tool using the Kobo Toolbox data collection tool. Logistic regression analyses were carried out to assess the strength of the association. Statistical significance was declared at p-value <0.05, and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the strength of the association. ResultAccording to the results of the current study, 288 patients, or 78% of the total, passed away within 72 hours of admission to the emergency department. The following variables were significantly associated to early mortality: delayed initial intervention (AOR = 2.338), red triage categories (AOR = 3.9), lack of investigation (AOR = 3.4), comorbid illness (AOR = 3.2), absence of prehospital treatment (AOR = 4.2), and road traffic accidents (AOR = 4.1). ConclusionThere was an increased early mortality rate seen in this investigation. The following factors were significantly associated with an early death in the emergency department: comorbidity, delayed intervention, red warning score, road traffic accidents, absence of prehospital treatment, and lack of diagnostic testing. By addressing the variables that are strongly linked to an early mortality, every intervention should be undertaken to reduce the risk of an early death.