Scottish Intensive Care Society Audit Group report on COVID-19
As at 15 March 2022

About this release

This release by Public Health Scotland is the tenth report on data from the Scottish Intensive Care Society Audit Group (SICSAG) relating to patients admitted to intensive care units (ICUs) and high dependency units (HDUs) across Scotland with COVID-19. This report differs from data published on 2 February 2022 and earlier where we have used a positive PCR test for SARS-CoV-2 virus to define COVID-19 critical care admissions. This report focusses on patients who are admitted to critical care units with a positive PCR test for SARS-CoV-2, comparing characteristics and outcomes for those with a clinically coded diagnosis of COVID-19 compared with those with a non-COVID-19 clinical diagnosis. In this report Wave 1 is defined as 1 March 2020 to 31 July 2020, wave 2 is defined 1 August 2020 to 17 May 2021, and wave 3 is defined as starting from 18 May 2021. The Omicron variant became the dominant strain in ICUs at the end of December 2021. The report uses 1 January 2022 as the date to mark this transition. This tenth report includes ICU activity up to 13 March 2022.

Main points

• During the period 1 March 2020 to 13 March 2022 there were 3,303 patients with a positive PCR test for SARS-CoV-2 admitted to intensive care units (ICUs) in Scotland. Of these, 296 patients have been admitted to ICUs since 01 January 2022, when the Omicron variant became the predominant variant in Scottish ICUs.

Daily count of ICU admissions with COVID-19 from 1 March 2020 to 9th January 2022.

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Number of ICU admissions with COVID-19

• During the period 1 March 2020 to 13 March 2022 there were 2,279 patients with a positive PCR test for SARS-CoV-2 admitted to high dependency units (HDUs) in Scotland. Of these patients, 251 were admitted since 1 January 2022.
• Since the Omicron variant became the predominant strain in ICUs in Scotland, the definition of critical care COVID-19 cases used by SICSAG, which relies on PCR testing to identify cases, no longer identifies patients admitted with COVID-19 disease with sufficient accuracy.
• Since 1 January 2022, only 26% of ICU admissions defined using the previous definition, had COVID-19 as the primary reason for admission to critical care on clinical case note review. In a further 14%, COVID-19 may have contributed to the reason for admission, though was not the primary reason. In 60% of admissions, the positive PCR test was coincidental to the reason for admission.
• Using the coded reason for admission to critical care in the SICSAG database to identify cases of COVID-19, out of 54 admissions that had COVID-19 coded as the admission diagnosis, 93% (50) had this diagnosis confirmed on case note review as the primary reason for admission, However, a further 17 cases of COVID-19 were not identified as they had a non-COVID-19 coded reason for admission.
• A revised method to identify critical care COVID-19 cases using the coded reason for admission to critical care recorded in the SICSAG database would correctly identify 75% of all cases of COVID-19, but would not capture cases in which COVID-19 contributed to the reason for admission. Furthermore, it would not reflect the resource implications associated with isolating patients with a positive SARS-CoV-2 test from other patients.
• Using this revised method to identify cases, only 29% of ICU admissions and 27% of HDU admissions admitted since 1 January 2022 with a positive SARS-CoV-2 PCR test are defined as COVID-19 admissions.

Background

The Scottish Intensive Care Society Audit Group (SICSAG) is the national adult critical care audit and quality assurance programme. It benefits from a close collaboration between the Scottish Intensive Care Society and Public Health Scotland. The audit has complete, national coverage of all admissions to intensive care units (ICUs) and combined critical care units in Scotland.

Since the start of the COVID-19 outbreak, SICSAG has transformed its systems to provide daily data to inform the response to the pandemic across Scotland. The full report describes the admission frequency, demographics, activity and outcomes for patients with laboratory confirmed COVID-19 disease admitted to Scottish units. It includes admissions to adult ICUs, combined intensive care/high dependency units, and areas of hospitals which have been repurposed to provide intensive care. In this report, the term 'ICU' refers to these three types of facility. It also includes admissions to standalone adult high dependency units (HDUs), as well as areas of hospitals which have been repurposed to provide high dependency care. However, not all repurposed HDUs were able to contribute data to the audit. The report does not include admissions to paediatric/neonatal ICUs and HDUs.

This eighth report compares characteristics and outcomes for admissions between the first, second and third waves of the pandemic.

Further information

Further information is available from the SICSAG website.

The next release of this publication will be on an ad hoc basis.