Update on pressure ulcer diagnosis and management: Leveraging Fluorescence and Thermal Imaging

Introduction: Pressure injuries (PIs) present a significant challenge for both patients and healthcare providers, leading to pain and discomfort, complications, increased healthcare costs, and the potential for litigation against sites of service. Effective prevention and treatment are essential for faster healing and improved outcomes. The present study aims to explore a novel strategy for the prevention and management of PIs that integrates thermal imaging and fluorescence imaging into the assessment of PI-prone patients.  Methods:A 25-patient case series that prospectively describes fluorescence imaging findings in a range of pressure injuries in different stages. Data on patient and wound characteristics and location, treatment changes and choices pre and post-fluorescence imaging, as well as associated complications, were recorded and analyzed. A smaller set of patients with severe mobility issues and reportedly high risk of pressure injury development (n=4, 3 inpatients, 1 outpatient with severe mobility issues) were additionally included. Their sites of pressure were scanned with the thermal imaging module and the findings were recorded.  Results: The patient's mean age was 67 [9 – 97]. Most patients were men (55%), the majority had a single active PI ( Ischial 39%, Sacral/Coccygeal 45%) while 16% had an active PI on two simultaneous locations ( Heel/Sacral/ Ischial/Coccygeal). 70% of active PIs had positive fluorescence signals. SOC treatment was directed at the outset in 100% of the cases, and enhanced and modified based on fluorescence guidance in 58% of the follow-up appointments. Fluctuating bacterial loads were evident in 30% of the patients, highlighting the importance of continuous fluorescence follow-ups. Thermal imaging showed regions of warmer temperature corresponding to areas of increased pressure, even in the absence of clinical signs. When incipient PI clinical signs were present, temperature in the center tended to decrease in relation to the healthier surrounding tissues.  Discussion: Pressure injuries prevention and management needs optimization. Leveraging medical technology to obtain better outcomes should not be overlooked. By integrating these advanced imaging techniques into care protocols, healthcare providers have a potential solution to enhance patient care, reduce the burden on healthcare systems, and mitigate legal risks.References: