Tramadol poisoning is a significant health problem and it is one of the most common reasons for visiting emergency departments (EDs). Factors that help to predict overall tramadol poisoning related fatality have rarely been elucidated. So, the aim of this work is to identify predictors for poisoning-related outcome in tramadol overdose by documenting the relationship between demographic, clinical characteristics, laboratory data, emergency interference and inhospital mortality among patients presented with acute tramadol overdose in the Poison Control Centre (PCC), Ain Shams University Hospitals. Between the first of January 2011 and the end of December 2011 we prospectively recruited tramadol poisoned patients presented to the emergency department (ED) of Poison Control Center (PCC), Ain Shams University Hospitals in Egypt. Interviews were conducted with patients within 24 hours after admission. Comparisons between survived cases and deaths were done to identify predictors of fatality. A total of 1233 poisoning cases were recorded at the ED. Tramadol poisoning was common in the middle age (84.5%), 79.5% were males and history of addiction was reported in 76.6%. Tramadol abuse was detected in 80% of all mortalities. Deaths were common among males (80%). The significant predictors for fatality included delay time, abnormal heart rate, abnormal blood pressure, abnormal respiratory rate, skin changes, GCS ≤ 10,  blood glucose, blood pH, endotracheal intubation, and need for mechanical ventilation. It could be concluded that abnormalities of heart rate, blood pressure, respiratory rate, conscious level, blood sugar, blood pH and the need for emergency respiratory interference are important predictors for the outcome of tramadol overdosed patients in the EDs.