Background: Across the globe, carbon monoxide (CO) poisoning is a leading cause of morbidity and mortality. It is regarded as one of the potentially predictable health-related disorders despite the high death rate. The scoring systems are straightforward diagnostic and early result prediction techniques that are easily applied. Aim: To evaluate two scoring systems used in emergency for early prediction of acute CO toxicity outcomes. Methods: This prospective observational cohort study was conducted on 36 cases of acute CO intoxication presented to the Poison Control Center of Zagazig University Hospitals (PCC- ZUH), emergency department and intensive care units (ICU) of ZUH. Two scoring systems were assessed. Results: TheReceiver operator characteristic curve (ROC) curve for modified early warning score (MEWS) and poison severity score (PSS) showed excellent validity results with 100% sensitivity and specificity in prediction of mortality in cases of acute carbon monoxide toxicity. Conclusion: MEWS and PSS are simple, easy, rapid, reliable and applicable scoring systems that save time and don’t require several laboratory variables which could be unavailable at admission or highly qualified personnel. Hence, they could be good predictors of poor outcomes, they may be suitable for prognostic evaluation of CO poisoning on admission and can help in followup patients during hospitalization and determining whether the patient will be admitted to the ward or ICU from the start Keywords: Scoring Systems, Carbon Monoxide, Acute Toxicity, Outcome