Stroke is the brain equivalent of a heart attack. It is one of the most common causes of morbidity and mortality worldwide and is a prominent cause of death, disability and dementia in sub-Saharan Africa (SSA). Hence, the purpose of this study was to assess the clinical characteristics and treatment outcomes among hospitalized stroke patients at Nekemte referral hospital (NRH).Retrospective cross sectional study design was conducted on randomly selected stroke patients admitted to medical wards of NRH from 2013 to 2017.Among 364 patients included in the study, 208 (57.1%) were males and the mean age of the patients was 59.66 ± 13.4 years. Regarding types of stroke, 192 (52.7%) were diagnosed as having ischemic stroke. During admission 132 (36.3%) patients complained left side body weakness (hemiparesis) and the major risk factor identified was hypertension 230 (63.2%). Overall, 65.4% of patients had poor outcome while 34.6% of patients had good out comes (improved). Being illiterate /unable to read and write (AOR = 3.94, 95% CI: 1.31-11.76, P = 0.01), attending secondary school (AOR = 3.6, 95% CI: 1.4-9.17, P = 0.007) and length of hospital stay >5 days (AOR = 2, 95% CI: 1.04-3.86, P = 0.037) were independent predictors of poor treatment outcome.About two third of the patients had poor treatment outcome. Educational status and mean length of hospital stays were independent predictors of poor treatment out-comes. An emergency care setup capable of early patient evaluation, identification and management of stroke complications is crucial to overcome early stroke related mortality.