Clinical utility of infrared thermography for pressure injury assessment and nursing decision-making: a systematic review

Pressure injury can develop before visible skin changes are apparent, creating a need for adjunctive bedside methods that provide objective information about local tissue responses. Infrared thermography (IRT) has been investigated for early identification, deep-tissue assessment, wound monitoring and nursing decision support, but its clinical utility is uncertain because thermal findings and implementation approaches vary substantially. We conducted a systematic review with narrative synthesis in accordance with PRISMA 2020. PubMed, Embase, Web of Science, CINAHL, China National Knowledge Infrastructure, SinoMed, Wanfang Data and the China Science and Technology Journal Database were searched from inception to 9 August 2026. Clinical studies of adults at risk of or affected by pressure injury were eligible when IRT was evaluated for assessment, prediction, monitoring or clinical implementation. Two reviewers independently screened records. Evidence was synthesised across prespecified clinical domains, and risk of bias was assessed using design-appropriate appraisal tools. Meta-analysis was not undertaken because of substantial clinical and methodological heterogeneity. The review was not prospectively registered. Thirty-five reports representing 34 independent studies were included. IRT identified local thermal abnormalities associated with early or clinically occult tissue changes and was also used to monitor healing, deterioration, undermining and recurrence. Both relative warming and relative cooling were associated with adverse tissue states in different contexts. Anatomical sites, regions of interest, reference areas, acquisition conditions, temperature-difference definitions and outcomes varied substantially, preventing a defensible universal thermal threshold. Narrative interpretations relied substantially on studies with methodological concerns, notably few outcome events, small samples, internally derived thresholds, limited confounding control and absent independent external validation. Studies reporting nursing process changes or differences in pressure injury incidence generally used multicomponent care pathways, so their effects could not be isolated to IRT. IRT may provide adjunctive site-specific information for pressure injury assessment, but its independent contribution to improved clinical outcomes remains unestablished. The assessment-and-response pathway proposed in this review has not been clinically validated. Standardised prospective studies are needed to test the incremental effects of IRT on nursing decisions and patient-important outcomes.