ObjectiveThis study aims to assess compliance with medical protocols and outcomes, as well as determine the consistency in clinical practice across different Pediatric Emergency Departments (PED) in public sector hospitals of a low-middle income country. MethodsA retrospective analysis was conducted on patients presenting to PEDs of five public sector hospitals, namely Civil Hospital Karachi (CHK), National Institute of Child Health (NICH), Abbasi Shaheed Hospital (ASH), Sheikh Zayed Hospital Larkana (LRK), and Ghulam Muhammad Mahar College Hospital Sukkur (SKR). The analysis covered a three-month period from February 1, 2023, to April 30, 2023. Patients diagnosed with Asthma, Sepsis, and Septic Shock during the study duration were included. Outcomes for each disease were evaluated based on compliance with standardized protocols. ResultsA total of 13,240 patients were diagnosed with the three diseases during the study period. Of these, 74% (n = 9751) had Sepsis, 12% (n = 1591) had Asthma, and 14% (n = 1898) had Septic Shock. The overall compliance rate for the three diseases was 77% (n = 10,240). Adherence to standard protocols was 98% (n = 1561) for Asthma, 85% (n = 8240) for Sepsis, and 23% (n = 439) for Septic Shock across the five emergency departments. Of the patients who were managed according to standard protocol, 31% (n = 3135) were discharged, 30% (n- 3094) were admitted, 11% (n = 1151) were referred, 15% (n = 1501) left against medical advice and 13% (n = 1359) did not survive. On the other hand, in patients where there was noncompliance to standard protocols, 27% (n = 805) did not survive, 27% (n = 807) were discharged, 24% (n = 710) were admitted, 8% (n = 260) were referred and 14% (n = 418) left against medical advice. ConclusionThe majority of PED demonstrated good compliance with standardized practices. However, this study identified areas that require attention and further training, especially early management of septic shock where compliances seem alarmingly low. Our data analysis indicates that adherence to guidelines has resulted in uniformity in clinical practice and the provision of early evidence-based quality care. Nevertheless, there is still room for improvement in ensuring consistent adherence to medical protocols in pediatric emergency settings and thus improving patient outcomes.