Clinical Validation of Object Detection Models for AI-Based Pressure Injury Stage Classification

Background/Objectives: Pressure injury stage classification was performed using object detection models to address inconsistencies in clinical assessment due to variability in nurses' experience and education levels. Methods: A dataset of 1282 pressure injury images from a medical institution was used to train and compare five representative architectures, YOLOv5x, YOLOv7, YOLOv8x, YOLOv8n, and YOLOv11x, and Faster R-CNN across Stages 1-4, excluding Deep Tissue Injury and unclassified cases. A mobile application incorporating YOLOv7 was deployed at Eulji University Daejeon Medical Center and tested by 10 nurses over 2 weeks, processing 46 cases. Results: YOLOv7 demonstrated superior performance with mAP@0.5 of 0.97 and mAP@0.5:0.95 of 0.68, achieving 93% accuracy for Stage 2 classification, the most challenging diagnostic category. Clinical validation demonstrated 87% diagnostic accuracy, 4.0/5 user satisfaction, and workflow improvement with assessment time reduced from 4-6 min to 1 min. The application proved valuable as both a diagnostic support tool and educational resource for novice nurses, with zero critical misclassifications recorded. Conclusions: This study establishes the practical utility of AI-based pressure injury classification systems in clinical practice and their potential for enhancing nursing competency and workflow efficiency.