Use of infrared thermography in the early detection of pressure ulcers: a narrative review
Keywords:
pressure ulcers, infrared thermography, nursing, early detection, CareAbstract
Background:
Pressure ulcers constitute a significant public health concern and remain a key indicator of the quality and safety of nursing care. Early identification of tissue damage is essential for effective prevention strategies; however, visual skin assessment is often insufficient, particularly in early-stage lesions and in individuals with higher skin phototypes. Infrared thermography (IRT) has emerged as a non-invasive imaging technique capable of detecting subclinical microvascular and inflammatory changes prior to the onset of visible skin alterations.
Objective:
To synthesise the available evidence on the use of infrared thermography for the early detection, prevention and monitoring of pressure ulcers, with a specific focus on its applicability within nursing practice.
Methods:
A narrative review of the literature was conducted through a structured search of PubMed, CINAHL Complete and Scopus. Original studies published between 2016 and 2025 that examined the application of infrared thermography in patients at risk of, or diagnosed with, pressure ulcers were included. The study identification and selection process was described in accordance with the PRISMA 2020 recommendations.
Results:
Twenty-two studies, predominantly observational in design, were included. The evidence consistently indicated that infrared thermography enables the identification of thermal alterations in intact skin before the appearance of clinically observable signs of pressure-related tissue damage. Additionally, infrared thermography demonstrated utility in monitoring lesion progression and prognosis. Studies evaluating the influence of skin tone reported that thermal patterns were largely independent of skin phototype, highlighting the potential of infrared thermography to mitigate diagnostic inequities associated with visual assessment alone.
Conclusions:
Infrared thermography represents a promising adjunct to conventional nursing assessment for the early detection and management of pressure ulcers. Nonetheless, methodological heterogeneity and the lack of standardised clinical protocols underscore the need for further prospective, multicentre studies to support its widespread clinical implementation.
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References
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler. EPUAP/NPIAP/PPPIA: 2019.
Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud. 2020 May;105:103546. doi: 10.1016/j.ijnurstu.2020.103546. Epub 2020 Jan 31. PMID: 32113142.
Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, Defloor T, Nixon J; European Quality of Life Pressure Ulcer Project group. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009 Jul;57(7):1175-83. doi: 10.1111/j.1532-5415.2009.02307.x. Epub 2009 May 21. PMID: 19486198.
Coleman S, Gorecki C, Nelson EA, Closs SJ, Defloor T, Halfens R, Farrin A, Brown J, Schoonhoven L, Nixon J. Patient risk factors for pressure ulcer development: systematic review. Int J Nurs Stud. 2013 Jul;50(7):974-1003. doi: 10.1016/j.ijnurstu.2012.11.019. Epub 2013 Feb 1. PMID: 23375662.
Bennett G, Dealey C, Posnett J. The cost of pressure ulcers in the UK. Age Ageing. 2004 May;33(3):230-5. doi: 10.1093/ageing/afh086. PMID: 15082426.
Demarré L, Van Lancker A, Van Hecke A, Verhaeghe S, Grypdonck M, Lemey J, Annemans L, Beeckman D. The cost of prevention and treatment of pressure ulcers: A systematic review. Int J Nurs Stud. 2015 Nov;52(11):1754-74. doi: 10.1016/j.ijnurstu.2015.06.006. Epub 2015 Jun 25. PMID: 26231383.
Díaz-Herrera MÁ, González-Durán M, Rodríguez-Martínez FJ, Tujillo-Flores G, Tuset-Mateu N, Verdú-Soriano J, Gea-Caballero V, Sanllorente-Melenchón A, Almeda-Ortega J, Cunillera-Puértolas O, Acedo-Anta M, Martínez-Riera JR. The financial burden of chronic wounds in primary care: A real-world data analysis on cost and prevalence. Int J Nurs Stud Adv. 2025 Feb 14;8:100313. doi: 10.1016/j.ijnsa.2025.100313. PMID: 40535786; PMCID: PMC12175658.
Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987 Jul-Aug;36(4):205-10. PMID: 3299278.
Norton D, McLaren R, Exton-Smith AN. An Investigation of Geriatric Nursing Problems in Hospital. London: Churchill Livingstone; 1962.
Fuentelsaz Gallego C. Validación de la Escala EMINA: un instrumento de valoración del riesgo de desarrollar úlceras por presión en pacientes hospitalizados. Enfermería Clínica 2001; 11 (3 ): 97-103.
Dhoonmoon L, Nair HKR, Abbas Z, Andrews E, McConnie S, Pearson J, Waheed M, Wijeyaratne M. Wound care and skin tone: Signs, symptoms and terminology for all skin tones. International Consensus Document. London: Wounds International; 2023.
Ring EF, Ammer K. Infrared thermal imaging in medicine. Physiol Meas. 2012 Mar;33(3):R33-46. doi: 10.1088/0967-3334/33/3/R33. Epub 2012 Feb 28. PMID: 22370242.
Nakagami G, Sanada H, Iizaka S, Kadono T, Higashino T, Koyanagi H, Haga N. Predicting delayed pressure ulcer healing using thermography: a prospective cohort study. J Wound Care. 2010 Nov;19(11):465-6, 468, 470 passim. doi: 10.12968/jowc.2010.19.11.79695. PMID: 21135794.
Kesztyüs, D.; Brucher, S.; Wilson, C.; Kesztyüs, T. Use of Infrared Thermography in Medical Diagnosis, Screening, and Disease Monitoring: A Scoping Review. Medicina 2023, 59, 2139. https:// doi.org/10.3390/medicina59122139
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124(6):869–871.
Jiang X, Wang Y, Wang Y, Zhou M, Huang P, Yang Y, Peng F, Wang H, Li X, Zhang L, Cai F. Application of an infrared thermography-based model to detect pressure injuries: a prospective cohort study. Br J Dermatol. 2022 Oct;187(4):571-579. doi: 10.1111/bjd.21665. Epub 2022 Jun 13. PMID: 35560229.
Cai F, Jiang X, Hou X, Wang D, Wang Y, Deng H, Guo H, Wang H, Li X. Application of infrared thermography in the early warning of pressure injury: A prospective observational study. J Clin Nurs. 2021 Feb;30(3-4):559-571. doi: 10.1111/jocn.15576. Epub 2021 Jan 26. PMID: 33258199.
Simman R, Angel C. Early Identification of Deep-Tissue Pressure Injury Using Long-Wave Infrared Thermography: A Blinded Prospective Cohort Study. Adv Skin Wound Care. 2022 Feb 1;35(2):95-101. doi: 10.1097/01.ASW.0000790448.22423.b0. PMID: 34469910.
Aloweni FAB, Ang SY, Chang YY, Ng XP, Teo KY, Choh ACL, Goh IHQ, Lim SH. Evaluation of infrared technology to detect category I and suspected deep tissue injury in hospitalised patients. J Wound Care. 2019 Dec 1;28(Sup12):S9-S16. doi: 10.12968/jowc.2019.28.Sup12.S9. PMID: 31825768.
Xu Y, Xu M, Huang P, Zhu Q, Jiang X, Cai F. Infrared thermography for assessing skin temperature characteristics of postoperative blanching erythema and stage 1 pressure injuries. J Tissue Viability. 2025 Nov;34(4):100963. doi: 10.1016/j.jtv.2025.100963. Epub 2025 Oct 30. PMID: 41207079.
Bilska A, Stangret A, Pyzlak M, Wojdasiewicz P, Szukiewicz D. Skin surface infrared thermography in pressure ulcer outcome prognosis. J Wound Care. 2020 Dec 2;29(12):707-718. doi: 10.12968/jowc.2020.29.12.707. PMID: 33320753.
Koerner S, Adams D, Harper SL, Black JM, Langemo DK. Use of Thermal Imaging to Identify Deep-Tissue Pressure Injury on Admission Reduces Clinical and Financial Burdens of Hospital-Acquired Pressure Injuries. Adv Skin Wound Care. 2019 Jul;32(7):312-320. doi: 10.1097/01.ASW.0000559613.83195.f9. PMID: 31192867; PMCID: PMC6716560.
Lin YH, Chen YC, Cheng KS, Yu PJ, Wang JL, Ko NY. Higher Periwound Temperature Associated with Wound Healing of Pressure Ulcers Detected by Infrared Thermography. J Clin Med. 2021 Jun 29;10(13):2883. doi: 10.3390/jcm10132883. PMID: 34209633; PMCID: PMC8269037.
Lin L, Zhuang D, Guo H, Zheng M, Zhu Q, Xu Y, Jiang X, Cai F. Application of infrared thermography for predicting pressure injury healing: A prospective study. J Tissue Viability. 2025 May;34(2):100857. doi: 10.1016/j.jtv.2025.100857. Epub 2025 Jan 9. PMID: 39826281.
Kanazawa T, Kitamura A, Nakagami G, Goto T, Miyagaki T, Hayashi A, Sasaki S, Mugita Y, Iizaka S, Sanada H. Lower temperature at the wound edge detected by thermography predicts undermining development in pressure ulcers: a pilot study. Int Wound J. 2016 Aug;13(4):454-60. doi: 10.1111/iwj.12454. Epub 2015 Jul 24. PMID: 26212623; PMCID: PMC7949717.
Cox J, Kaes L, Martinez M, Moles D. A Prospective, Observational Study to Assess the Use of Thermography to Predict Progression of Discolored Intact Skin to Necrosis Among Patients in Skilled Nursing Facilities. Ostomy Wound Manage. 2016 Oct;62(10):14-33. PMID: 27768578.
Oohashi F, Ogai K, Takahashi N, Arisandi D, Urai T, Sugama J, Oe M. Increased temperature at the healed area detected by thermography predicts recurrent pressure ulcers. Wound Repair Regen. 2022 Mar;30(2):190-197. doi: 10.1111/wrr.12999. Epub 2022 Feb 18. PMID: 35180332.
Çor O, İlçe AÖ, Demiraran Y. Evaluation of surgery-related pressure injury with infrared thermal camera in the postoperative intensive care unit. J Tissue Viability. 2025 Nov;34(4):100944. doi: 10.1016/j.jtv.2025.100944. Epub 2025 Jul 22. PMID: 40714414.
Miao A, Lin C, Ni Y, Yin S, Lv C, Huang H, Jiang X, Zhou H. Effectiveness of skin interface pressure and temperature monitoring for pressure injury prevention in paraplegic patients: a comparative study. Front Public Health. 2025 Oct 7;13:1521948. doi: 10.3389/fpubh.2025.1521948. PMID: 41127593; PMCID: PMC12537892.
Cwajda-Białasik J, Filipska-Blejder K, Mościcka P. Medical thermography in the diagnosis of pressure ulcers: a narrative review. Journal of Wound Management. 2025;26(2):100-110.
Bates-Jensen BM, Jordan K, Jewell W, Sonenblum SE. Thermal measurement of erythema across skin tones: Implications for clinical identification of early pressure injury. J Tissue Viability. 2024 Nov;33(4):745-752. doi: 10.1016/j.jtv.2024.08.002. Epub 2024 Aug 22. PMID: 39214728.
Jordan K, John GT, Chung A, Asare-Baiden M, Hertzberg VS, Ho JC, Sonenblum SE. Impact of skin tone and cupping on erythema and thermal imaging measurements. Sci Rep. 2025 Nov 27;15(1):42575. doi: 10.1038/s41598-025-24823-w. PMID: 41309734; PMCID: PMC12663286.
Sonenblum SE, Jordan K, John GT, Chung A, Asare-Baiden M, Pelkmans J, Gichoya JW, Hertzberg VS, Ho JC. Impact of skin tone, environmental, and technical factors on thermal imaging. PLoS One. 2025 Sep 10;20(9):e0325091. doi: 10.1371/journal.pone.0325091. PMID: 40929141; PMCID: PMC12422453.
Asare-Baiden M, Sonenblum SE, Jordan K, Chung A, Gichoya JW, Hertzberg VS, Ho JC. A Feasibility Study of Thermography for Detecting Pressure Injuries Across Diverse Skin Tones. medRxiv [Preprint]. 2024 Oct 16:2024.10.14.24315465. doi: 10.1101/2024.10.14.24315465. PMID: 39484234; PMCID: PMC11527050.
Burke OM, Kirsner RS, Elman SA. Retrospective analysis of thermographic imaging in early detection of pressure injuries. Wound Repair Regen. 2025 Jan-Feb;33(1):e70003. doi: 10.1111/wrr.70003. PMID: 39949176.
Burke OM, Bilik SM, Restrepo A, Garcia J, Frischholz ZJ, Pire C, Sepulveda M, Zuniga SV, Zincone LL, Gonzalez G, Cahill J, Guo S, Thichava J, Elman SA. Prospective Evaluation of Thermographic Imaging for Early Detection of Pressure Injuries: A Follow-Up Study. Wound Repair Regen. 2025 Nov-Dec;33(6):e70119. doi: 10.1111/wrr.70119. PMID: 41366606; PMCID: PMC12689484.
Wilson HJE, Patton D, Budri AMV, Boland F, O'Connor T, McDonnell CO, Rai H, Moore ZEH. The correlation between sub-epidermal moisture assessment and other early indicators of pressure ulcer development: A prospective cohort observational study. Part 2. The correlation between sub-epidermal moisture assessment, temperature, epidermal hydration and pain. Int Wound J. 2024 Oct;21(10):e70058. doi: 10.1111/iwj.70058. PMID: 39379178; PMCID: PMC11461043.
Carpenito LJ. Nursing diagnosis: Application to clinical practice. 14th. ed. Philadelphia: Lippincott-Willians & Wilkins; 2013.
NNNConsult. Herramienta online para la consulta y diseño de planes de cuidados de enfermería [Internet]. Elsevier; [cited 2026 Jan 07]. Available from: https://www-nnnconsult-com.mergullador.sergas.es/
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