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

This retrospective observational study examined the timing and sequence of clinical events during terminal hospitalization in pediatric oncology patients with progressive, treatment-refractory disease. The study included 54 children with solid tumors who died as inpatients at a tertiary center in Turkey between 2015 and 2025. Clinical events were mapped from admission to death, including both the time from admission to event onset and the interval from event onset to death. The most common diagnoses were neuroblastoma, Ewing sarcoma, and osteosarcoma. Patients experienced a mean of 3.1 ± 1.9 clinical events during terminal hospitalization. The most frequent events were intubation (64.8%), hypotension (57.4%), sepsis (48.1%), and electrolyte imbalance (35.2%). Temporal analysis showed that sepsis and hypotension occurred relatively early, with median onset times of 15.5 and 15 days after admission, respectively, whereas acute renal failure emerged later, with a median onset of 49 days. New-onset hypotension, intubation, and acute renal failure were closely associated with imminent death, with median intervals from event onset to death of 6, 7, and 3.5 days, respectively. These findings suggest that terminal decline in pediatric oncology follows measurable temporal patterns, and objective events such as hypotension, intubation, and acute renal failure may help clinicians recognize irreversible deterioration earlier.