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

AIM: To evaluate 25-year national trends in paediatric intensive care utilisation, patient outcomes, rehospitalisations and regional resource distribution in Israel. METHODS: Retrospective, population-based cohort study of all paediatric (0-17 years) ICU hospitalisations in Israel between 1999 and 2023. We linked the National Hospital Discharge Register with paediatric ICU bed capacity data and Central Bureau of Statistics population estimates. Outcomes included age-adjusted ICU admission rates, in-hospital and 1-year post-discharge mortality, rehospitalisation at 7, 30 and 365 days, and paediatric ICU beds per 100 000 children. RESULTS: The proportion of hospitalisations involving ICU care increased from 3.53% to 6.1%. In-hospital ICU mortality declined from 4.3% to 2.3%, and 1-year post-discharge mortality decreased from 3.2% to 2.6%. One-year rehospitalisation occurred in 46% of ICU survivors versus 29% of non-ICU patients. Between 2018 and 2023, national paediatric ICU bed capacity rose by 23%, yet regional bed-to-population ratios varied up to 2.6-fold. CONCLUSIONS: Over 25 years, paediatric ICU utilisation and capacity nearly doubled, accompanied by reductions in mortality. However, persistently high rehospitalisation rates and regional disparities underscore the need for structured post-ICU follow-up, standardised admission criteria, equitable resource allocation and further research to clarify drivers of ICU utilisation and long-term outcomes.