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deep-tissue pressure injury, DTPI, early detection, long-wave infrared thermography, LWIT, tissue perfusion, visual assessment



  1. Simman, Richard MD, FACS, FACCWS
  2. Angel, Carol MD


BACKGROUND: The current clinical standard for diagnosing deep-tissue pressure injury (DTPI) is visual inspection. This method is subjective and only presents to the observer the external "picture;" deeper tissues are disguised from the observer. In contrast, long-wave infrared thermography (LWIT) can capture an image of the area of concern and detect tissue temperature relative to the level of tissue perfusion.


OBJECTIVE: To determine the efficacy of a handheld LWIT device and software solution as an adjunct to the current clinical standard of visual skin assessment to detect nonvisual pathophysiologic changes of DTPI.


METHODS: Investigators performed a blinded, prospective cohort study scanning participants' sacral area and bilateral heels with the LWIT device. Follow-up imaging took place throughout patient stays (on admission and 3, 7, 14, and 25 days thereafter). Clinicians were blinded to the LWIT images, and all participants received standard care for the prevention and treatment of wounds.


RESULTS: Among the 70 participants enrolled in this study, there were 131 anatomical areas with intact skin at the time of admission. Four areas with initially intact skin progressed to visually identifiable DTPI. On all four of these areas, the LWIT device identified a previsual temperature anomaly before there existed a visually identifiable DTPI.


CONCLUSIONS: The outcomes of this study suggest objective and quantitative documentation of temperature change using the LWIT device can serve as an indication of DTPI formation before visual identification is possible. Accordingly, it may allow for earlier detection of DTPI, decreasing the risk of associated complications to the patient and allowing for earlier, targeted intervention.