Introduction: Sepsis is life-threatening organ dysfunction caused by a deregulated host response to infection. It is one of the leading causes of mortality among children worldwide. It is also the second leading cause of death for 1-14 years of age and fourth leading cause of death for under 1 year of age. Appropriate and timely recognition of sepsis is a prerequisite for starting goaldirected therapy bundles. Even though sepsis is common, few researches are done in the area of study and the country. Objectives: The study was conducted to assess the clinical presentations and outcomes of sepsis among children admitted in pediatric emergency department of Tikur Anbesa specialized hospital, Addis Ababa, Ethiopia. Methodology: Institutional based retrospective chart review method had been conducted by using standard checklist questionnaire for sepsis patients admitted in pediatric emergency unit of Tikur Anbesa specialized hospital from January 1, 2017 to January 1, 2019. Data has been checked, analyzed, and interpreted by using SPSS Software. The result was presented by tables, bar charts and pie charts. Result: A total of 305 sepsis patients were studied. Of this 3.9% and 2.9% were diagnosed as a complication of sepsis which were sever sepsis and septic shock during admission. The most common site of infection was chest focus accounted for (71%) of patients. The median value of SIRS criteria was (IQR=2) and most patients (79.3%) were alert. From the total studied sepsis patients, 13.4% have co morbidities. Majority of patients (81%) were started antibiotics more than 1 hour after triage. About 55.1% of studied patients were discharge and 8.2% were death. Of this, 3.6 %( n=11) of the death were within 48 hours. Conclusion and recommendation: sepsis is significant concerning condition among children due to its cause of mortality in the world. Majority patients had breathing problem; cardiac concomitant diseases and majority were treated after one hour triage time in this study. As a result every health providers should be awared for clinical presentations and treatments of sepsis.