Tramadol is a centrally acting synthetic opioid analgesic and its abuse has been widely distributed in the Egyptian community. Poisoning severity score (PSS) and Glasgow coma scale (GCS) are scoring systems employed to evaluate the severity of poisoning based on clinical characteristics. The aim of this study was to evaluate PSS and GCS in acute tramadol poisoned patients as predictors for tramadol poisoning severity. The study was carried out on 30 patients with acute tramadol poisoning who were admitted to Toxicology Unit of Tanta University Emergency Hospital in the period from the first of June 2013 to the end of November 2013. Patients who took mixed drugs, had psychic or medical disorders, aged less than 18 years or who were asymptomatic were excluded. Detailed history, thorough clinical examination and investigations were carried out. In addition, GCS and PSS were calculated. As regards demographic data, there was a significant increase among unemployed cases (50%), males (63.33%) and patients in the age group 18-30 years (73.33%). Suicidal poisoning was significantly higher compared to drug abuse and accidental cases (50%, 43.33%, and 6.67% respectively). As regards clinical data, patients presented with tachycardia (90%), hypertension (40%), tachypnea (33.33%), mild fever (23.33%), seizures (43.33%) and mydriasis (6.67%). GCS was significantly associated with ingested tramadol dose, pupil size, seizures, arterial blood gases (ABG) findings and tramadol level in urine (P<0.05). PSS was significantly associated with the ingested dose of tramadol, pre-hospitaliztion period and tramadol level in urine as well as GCS (p<0.05). Thus, it can be concluded that PSS and GCS were useful tools for determination of the severity of acute tramadol poisoning.