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Background & objectives: We have established a severity grading score (SGS) system for predicting the fatalityin Crimean-Congo hemorrhagic fever (CCHF) for the first time.Methods: This SGS has been set up by using several variables which were assumed to be associated withmortality according to the literature and also were considered to have clinical importance.Results: In all, 237 patients who had symptoms of CCHF for <5 days were included. The patients were groupedinto three categories according to the mortality risk by using SGS as follows : low or no risk, intermediate andhigh risk groups. A SGS <5 showed no association with mortality (there were 158 cases in this group and allsurvived). This group constituted 66.7% of all the patients with CCHF. A SGS 6–10 showed moderate risk ofmortality (10%) and seven out of 70 patients in this group died. SGS >11 means high risk for mortality (67%)and six out of 9 patients in this group died (p = 0.001). The sensitivity, specificity, accuracy, positive predictivevalue, and negative predictive value for >11 points of SGS were 67, 100, 98, 100, and 98%, respectively.Conclusions: This scoring system may help the clinicians to decide which patient to refer to a tertiary stephospital which may also decrease the cost and improve the functionality of healthcare staff.