From Triage to Outcome: How ED Parameters and Comorbidities Shape Pediatric Critical Illness Prognosis

Objective: To describe the characteristics of children presenting with red-code triage to a tertiary Pediatric Emergency Department (PED) and to evaluate the association between variables at PED presentation and hospitalization outcomes. Methods: This retrospective study included patients aged 0-16 years presenting to the PED with highest level of urgency at triage between 2021 and 2025. Demographic, clinical, laboratory, and outcome data were extracted from electronic medical records. Vital signs at presentation were categorized by severity using age-adjusted percentiles and established thresholds. Outcomes included hospital admission, PICU admission, need for advanced vital support (ALS) within 7 days, and hospitalization at 7 days. Univariable and multivariable logistic regression analyses were performed to identify predictors of outcomes. Results: Critically ill pediatric presentations accounted for 0.23% of PED attendances. Chronic comorbidities were present in 56.21%, mainly neuropsychiatric conditions. Seizures (33.99%) and respiratory conditions (25.49%) were the leading causes. Most patients were hospitalized (56.86% in ward, 20.26% in PICU). Invasive ventilation was required in 7.18% of patients and inotropic support in 3.92%. Increasing age was associated with significantly lower odds of both hospital admission (OR: 0.876, 95% CI: 0.783-0.976; p = 0.017) and PICU admission (OR: 0.890, 95% CI: 0.793-0.983; p = 0.031). Conversely, the need for advanced life support in the ED was independently associated with PICU admission (OR: 3.247, 95% CI: 1.345-7.997; p = 0.009). None of the evaluated ED clinical parameters were independently associated with 7-day outcomes. Conclusions: Our cohort demonstrates a high prevalence of chronic comorbidities, confirming their growing relevance in hospital resource allocation. Life-saving interventions were rarely required, underscoring the need for strategies to maintain medical competencies. Younger age was associated with an increased risk of hospitalization. Monitoring of clinical parameters in the ED, although a useful complementary measure, cannot replace a comprehensive medical assessment of the underlying condition.