Patient Profiles and Factors Associated with Escalated Care in a Southeast Ethiopian Pediatric Emergency Department: A Three-Year Retrospective Analysis

Background Pediatric emergency departments (PEDs) play a critical role in reducing childhood morbidity and mortality, particularly in low- and middle-income countries (LMICs), where infectious diseases and delayed healthcare-seeking remain prevalent. Evidence regarding treatment outcomes and predictors of escalated care in Ethiopian pediatric emergency settings are limited. Objective To assess patient profiles, treatment outcomes, and factors associated with escalated care among children presenting to the pediatric emergency department of Asella Referral and Teaching Hospital (ARTH), Southeast Ethiopia. Methods A retrospective cross-sectional study was conducted among pediatric emergency visits between 10 September 2022 and 10 September 2025. A total of 407 medical records were systematically sampled. Data were entered into KoboCollect and analyzed using SPSS version 27. Variables with p < 0.25 in bivariable analysis were entered into multivariable logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Statistical significance was declared at p < 0.05. Results Of 407 visits, 63.9% were male and 75.9% were under five years of age. Rural residents constituted 55.3% of cases. Pneumonia (19.2%) was the leading diagnosis. Nearly half (49.6%) required escalated care (admission, referral, ICU transfer, or death). Independent predictors included malnutrition (AOR = 13.25; 95% CI: 3.40–51.61), true emergency presentation (AOR = 7.59; 95% CI: 2.59–22.20), comorbidity (AOR = 7.30; 95% CI: 1.30–40.94), altered mental status (AOR = 5.75; 95% CI: 1.67–19.83), delayed presentation > 3 days (AOR = 5.66; 95% CI: 2.22–14.40), diarrhea complaint (AOR = 5.99; 95% CI: 1.09–39.30), presence of danger signs (AOR = 2.06; 95% CI: 1.09–3.86), and referral status (AOR = 1.91; 95% CI: 1.05–3.46). Conclusion Nearly half of pediatric emergency visits required escalated care. Clinical severity indicators, malnutrition, comorbidity, and delayed presentation were strong predictors. Strengthening triage systems and early risk identification is critical to improving pediatric emergency outcomes in resource-limited settings.