Deep learning-based pressure injury staging: a multicentre study involving 59 hospitals

Accurate assessment of pressure injury staging is essential for guiding appropriate care, reducing patient suffering, alleviating the healthcare burden, and improving quality of life. We aimed to develop a deep learning-based model for pressure injury recognition and to translate the best-performing model into a preliminary smartphone application.

We conducted a multicentre retrospective study using pressure injury images collected from 59 hospitals. We applied to the data set three artificial intelligence-based image analysis models, Mask R-convolutional neural network (CNN) with ResNet-18, Mask R-CNN with Swin Transformer, and Segmenting Objects by Locations, version 2. We assessed model performance using standard evaluation metrics, including precision-recall curves, average recall (AR), average precision (AP), and mean average precision (mAP). The model achieving the best overall performance was selected for subsequent translation into a smartphone-based tool.

We included a total of 1903 pressure injury images, with 1713 used for model training and 190 for validation. Among the models evaluated, Mask R-CNN with Swin Transformer demonstrated the highest overall performance (mAP = 0.894, AP₅₀ = 0.900, AP = 0.757, AR₁₀₀ = 0.792), surpassing the corresponding metrics of the other two models. The model, based on Mask R-CNN with a Swin Transformer, was integrated into a smartphone for preliminary translation.

The proposed deep learning-based system showed promising performance in pressure injury staging and may provide meaningful support for clinical decision-making. Future studies should focus on further validation and refinement using larger and more diverse data sets to enhance their applicability in routine clinical practice.