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From Survival to Recovery: 25 Years of Paediatric Critical Care Transformation in Israel
Yael Applbaum1, Shulamit Gordon1, Isaac Manaster2,3
1Division of Health Information, Ministry of Health, Jerusalem, Israel.
Insights
Paediatric intensive care (PICU) use and capacity in Israel doubled over 25 years, reducing mortality. However, high rehospitalisation rates and regional disparities persist, highlighting the need for improved post-PICU care and resource distribution.
Area of Science:
- Pediatric Critical Care Medicine
- Health Services Research
- Public Health Policy
Background:
- Paediatric intensive care unit (PICU) utilization has seen significant shifts globally.
- Understanding long-term trends in PICU care is crucial for resource planning and patient outcomes.
Purpose of the Study:
- To analyze 25-year national trends in pediatric intensive care utilization.
- To evaluate changes in patient outcomes, rehospitalizations, and regional resource distribution in Israel's PICUs.
Main Methods:
- Retrospective, population-based cohort study (1999-2023) of all pediatric ICU hospitalizations in Israel.
- Linked national discharge data with PICU bed capacity and population estimates.
- Analyzed ICU admission rates, mortality, rehospitalization, and PICU bed availability per capita.
Main Results:
- PICU utilization increased from 3.53% to 6.1% of hospitalizations.
- In-hospital and 1-year post-discharge mortality rates declined.
- One-year rehospitalization was higher in PICU survivors (46%) vs. non-ICU patients (29%).
- Pediatric ICU bed capacity increased 23% (2018-2023), but regional disparities persisted.
Conclusions:
- Over 25 years, pediatric ICU utilization and capacity nearly doubled, with reduced mortality.
- High rehospitalization rates and regional disparities necessitate structured post-PICU follow-up and equitable resource allocation.
- Further research is needed to understand drivers of ICU utilization and long-term outcomes.
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.
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