From Survival to Recovery: 25 Years of Pediatric Critical Care Transformation in Israel

Purpose: To evaluate 25-year national trends in pediatric intensive care utilization, patient outcomes, rehospitalizations, and regional resource distribution in Israel. Methods: Retrospective, population-based cohort study of all acute pediatric (0–17 years) hospitalizations in Israel from January 1, 1999, to December 31, 2023 (≈ 180 000 admissions), excluding neonatal and maternity ICU stays. We linked the National Hospital Discharge Register with pediatric ICU bed capacity data and Central Bureau of Statistics population estimates. Outcomes included age-adjusted ICU admission rates, in-hospital and one-year post-discharge mortality, rehospitalization at 7, 30, and 365 days, and pediatric ICU beds per 100 000 children. Trends were assessed in five-year intervals using SAS 9.4. Results: The proportion of hospitalizations involving ICU care increased from 3.3–6.5%. In-hospital mortality among ICU patients declined from 3.8–1.4% (63.2% relative reduction), and one-year post-discharge mortality decreased from 3.0–1.9% (36.7% relative reduction). One-year rehospitalization occurred in 46% of ICU survivors versus 29% of non-ICU patients (20% vs 3% requiring subsequent ICU). Between 2018 and 2023, national pediatric ICU bed capacity rose by 23%, yet regional bed-to-population ratios varied up to 2.6-fold. Conclusions: Over 25 years, Israeli pediatric ICU utilization and capacity nearly doubled, accompanied by marked reductions in mortality. However, persistently high rehospitalization rates and pronounced regional disparities underscore the need for structured post-ICU follow-up, standardized admission criteria, equitable resource allocation, and further research to clarify drivers of ICU utilization and long-term outcomes. Limitations include reliance on administrative data lacking individual illness-severity measures.