Use of infrared thermography as a preventive measure in the early detection of pressure injury: a scoping review protocol
Creators: name: Carvalho, Tânia Manuel Sousa
name: De Gouveia Santos, Vera Lucia Conceição
name: CHICONE, GISELE
name: Alves, Paulo
Publisher: name: Open Science Framework
Year: 2023
Subjects: subject: Medicine and Health Sciences
subject: Public Health
subject: Education
subject: Nursing
subject: FOS: Health sciences
subject: pressure injury
subject: thermography
subject: incidence
subject: pressure injury prevention
subject: skin temperature
subject: early diagnosis

description: Pressure injuries (PI) are frequent health problems worldwide and have become a matter of trust in health institutions. It leads to skin damage, psychosocial damage, pain, and increased costs for health institutions, most of the time as inevitable damage. These injuries are considered localized damage to the skin or underlying soft tissues, usually over a bony prominence or related to the use of medical devices or other devices6. A lesion may appear on intact skin or as an open ulcer and may be painful. Soft tissue tolerance to pressure and shear can also be supported by the patient's microclimate, nutrition, perfusion, comorbidities, and other conditions7,8 Its incidence and prevalence vary significantly according to the clinical and geographic environment where the patient is located. A recent systematic review showed a prevalence of 12.8%, an incidence of 5.4 per 10,000 patient days, and a rate of occupational injuries in hospitals of 8.4%9. Estimates indicate that, approximately and only in the United States, 1 to 3 million people develop PI, and 60,000 die from secondary complications10. Prevalence and incidence rates are generally higher in particular high-risk patients, such as those receiving palliative care11, those with spinal cord injuries12–14, neonates and children1510, and individuals in intensive care16–19. Although PI is considered an indicator of the quality of care provided, its identification, understanding of pathophysiology, and prevention still need to be discovered or neglected by many professionals, making follow-up/monitoring and management of results difficult20. The reduction in the incidence of PI starts with the prevention and identification of risk factors, possible through the permanent education of the multidisciplinary team, with practice based on evidence, in which the relationship with knowledge and clinical experiences is established21. Risk factors for the development of pressure ulcers in critically ill patients are mainly related to the use of vasopressor medications22, exposure to humidity, pressure, impaired sensory perception, sedation, patients on dialysis23,24, associated with other predictors already established, such as diabetes mellitus, change in body temperature6, as well as subepidermal humidity has been used as a predictor of the appearance of PI25–27. Thermogenesis or heat production is a fundamental process for life and represents the combined effects of nutrient metabolism, blood flow, and energy expenditure. Even the most minor thermogenic changes in some specific tissues can reflect changes and alterations of physiological function and diseases. Identifying and measuring these changes can provide knowledge for early diagnosis in several areas28. Several lesions can influence cutaneous blood flow, which can affect skin temperature29. Inflammation leads to hyperthermia, while degeneration, reduced muscle activity, and poor perfusion may be responsible for a hypothermic pattern30. Skin temperature depends on the presence or absence of perfusion of the dermis and subcutaneous tissues. When blood flow decreases in conditions such as peripheral vascular disease (PVD) in the lower extremities, skin temperature tends to be lower31. However, when impaired perfusion is restored, data from studies in healthy animals and humans indicate the return of blood flow accompanied by increased skin temperature over the pressure point32. The increase in temperature is attributed to a response to hyperemia and possibly reperfusion injury/inflammation after temporary capillary occlusion2,33. Destruction of blood vessels during skin injury reduces local perfusion and a secondary decrease in skin temperature in that area, which can be detected by thermography3,4. Previous observational studies have examined the effect of skin temperature on the development of PI in both acute and long-term care2,34,35. Studies have found changes in the skin temperature of pressure-damaged areas, with an increase in skin temperature of 1.2°C in the 24-96 hours before the development of PUs1. Aloweni et al. found an association between skin temperature with LP and intact skin. They analyzed the temperature among patients with stage 1 and deep tissue LP with a mean temperature of 31.1ºC; SD: 1.54) and in areas without LP (28.9ºC, SD: 3.47). The temperature difference was significant at 2.2°C; SD: 3.66; 95% confidence interval [CI] 0.324 to 4.087; p = 0.024331. Skin temperature measurement can serve as an objective and quantifiable approach in the early identification of PI. A preliminary search of JBI Evidence Synthesis, the Cochrane Library, PROSPERO, and MEDLINE revealed only one systematic review, but its focus differs from this proposed scoping review. Baron et al36. carried out a systematic review to evaluate the accuracy of the thermographic image in detecting LP, concluding that the quality of the thermographic image is limited. Our aim will explore the thermographic image as an early diagnosis in identifying changes in skin temperature in adults and elderly people, which is the change in tissue temperature that can predict the appearance of pressure injuries even before visible signs on the skin. In future analysis, the knowledge gained will inform future research and guide the preventive process of LP reliably and robustly, which can be used to compare skin temperature variables through thermography in patients at risk of developing PI. This scoping review aims to understand the extent and type of evidence in relation to the use of thermographic imaging in identifying skin temperature change as a predictor of pressure injury (PI) development