Background: Depressed skull fracture (DSF) is one of the commonest neurosurgicalrnemergencies in Ethiopia. The clinical outcome after surgical management and what factorsrnpredict the outcome is not well-studied, especially in low-income countries like Ethiopia. Ourrnstudy aimed to assess the clinical outcomes of DSF and identify predictors of the outcome inrnsurgically treated adult patients. rnMethodology: A prospective, multicenter, observational study was undertaken on 197 surgicallyrntreated patients with DSF from June 1, 2018, to June 30, 2020, at four selected neurosurgicalrnteaching hospitals in Ethiopia. Adult patients with clinically palpable or CT evidence of DSFrnwho underwent surgery for the primary indication of the DSF were included in this study. Datarnon patientsâ€Ÿ socio-demographics, mechanisms of injury, clinical findings at presentation,rnimaging, and intraoperative findings, and postoperative course was collected and analyzed. Thernoutcome was assessed by the extended Glasgow outcome scale (GOS-E): as favorable orrnunfavorable. Bivariate analysis was done to identify factors that correlate with the clinicalrnoutcome and multivariate logistic regression analysis was done to identify independentrnpredictors of the outcome. rnResults: The overall clinical outcome was favorable in 81.2% of 197 patients. The mean age ofrnparticipants was 27.77 +/- 10.21 years with a male to female ratio of 23.6:1. The most commonrnmode of injury was violence-related 157 (79.7%). The DSF was compound in 186 (94.4%). Posttraumaticrnrnmotor deficit and early posttraumatic seizures were witnessed in 24.4% and 8.1%rnrespectively. Based on post-resuscitation GCS 182(92.2%) patients had mild TBI, 12(6.1%)rnmoderate TBI, and only 3(1.5%) were in severe TBI. The most common site of fracture wasrnfrontal bone involved in 103 (52.3%) of cases, followed by parietal bone in 48 (24.4%).rnAssociated intracranial lesion was identified in 172 (87.3%) of cases. The median days ofrnhospital stay were 4.7 days. Totally 8(4.1%) patients underwent reoperation and the overallrnmortality was 0.5%. In bivariate and multivariate analysis, posttraumatic motor deficit (adjustedrnOR 13.8, 95% CI: 4.13-46.17, P=0.000), post-resuscitation GCS â‰¤13 (adjusted OR 10.36, 95%rnCI: 1.93-55.56, P=0.006), pneumocephalus on brain CT scan (adjusted OR 12.93, 95% CI: 3.1253.52,rnP=0.000),rnhospitalrnstayrnforrnâ‰¥rn3rndaysrn(adjustedrnORrn4.39,rn95%rnCI:rn1.18-16.3,rnP=0.027)rnrnandrnrnreoperationrnrn(adjusted OR 6.92, 95% CI: 1.091- 43.97, P=0.04) were statistically significantrnindependent predictors of unfavorable outcome. rnConclusion: The overall outcome of surgical treatment for DSF in this study was favorable. Thernpresence of motor deficit, post-resuscitation GCS â‰¤ 13, pneumocephalus, reoperation, andrnhospital stays for â‰¥ 3 days were independent predictors of an unfavorable outcome.