Temporal Patterns of Clinical Events as Markers of Terminal Decline in Pediatric Oncology Patients

Area of Science:

• Pediatric Oncology
• Palliative Care
• Clinical Informatics

Background:

• Pediatric oncology patients with progressive, treatment-refractory disease often require terminal hospitalization.
• Understanding the timing and sequence of clinical events during this phase is crucial for improving end-of-life care.

Purpose of the Study:

• To examine the temporal patterns of clinical events during terminal hospitalization in pediatric oncology patients.
• To identify specific clinical events associated with imminent death.

Main Methods:

• Retrospective observational study of 54 pediatric oncology inpatients who died between 2015 and 2025.
• Mapping of clinical events from admission to death, analyzing time from admission to event onset and event onset to death.
• Focus on common diagnoses: neuroblastoma, Ewing sarcoma, osteosarcoma.

Main Results:

• Patients experienced a mean of 3.1 clinical events during terminal hospitalization.
• Most frequent events included intubation (64.8%), hypotension (57.4%), sepsis (48.1%), and electrolyte imbalance (35.2%).
• Sepsis and hypotension occurred early (median onset 15.5 and 15 days), while acute renal failure emerged later (median onset 49 days).
• New-onset hypotension, intubation, and acute renal failure were linked to imminent death (median intervals of 6, 7, and 3.5 days, respectively).

Conclusions:

• Terminal decline in pediatric oncology patients exhibits measurable temporal patterns.
• Objective clinical events like hypotension, intubation, and acute renal failure can serve as early indicators of irreversible deterioration.
• These findings can aid clinicians in recognizing and managing the end-of-life trajectory more effectively.