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Clinical Research

(CR-009) Defining the Trombley Brennan Terminal Tissue Injury from a DTPI using Long Wave Infrared Thermography

Friday, April 10, 2026
Meredith Akerman, MS; Lily Thomas, PhD RN FAAN; Deanna Vargo, RN CWOCN
Introduction: Palliative care nurses observed skin changes in patients at end of life that appeared similar to pressure injuries at onset but differed in their evolution. Subsequent studies clinically differentiated TB-TTIs from DTPIs and concluded that TBTTIs are identifiable unavoidable changes with a unique pathophysiology. TB-TTIs are usually mislabeled as DTPIs, a reportable hospital-acquired condition. Accurate classification will enable clinicians to plan appropriate care and guide medical interventions while improving end of life care for patients and families.

Methods:

A prospective observational study was conducted in a 10-bed palliative care unit of a quaternary hospital. Patients aged 18 or older, newly presenting with skin changes consistent with DTPI or TB-TTI and without pre-existing pressure injuries, were eligible. Infrared thermographic imaging was performed using the Long Wave Infrared Thermography device to capture thermal and visual images of affected and adjacent skin. Temperatures and wound dimensions were analyzed.

Results:

After adjusting for age and gender, significant differences were found between DTPI and TB-TTI in mean (-2.07 vs. -0.21, p< 0.0001), maximum (-1.77 vs. 0.52, p=0.0434), and minimum (-1.85 vs. -0.22, p=0.0049) discolored tissue temperatures. TB-TTI wounds had a significantly higher percentage of area within ±1°C of normal skin temperature (89.16% vs. 54.94%, p=0.0011) compared to the adjacent tissue. No significant differences were observed in wound size or perimeter.

Discussion: LWIT successfully identified a distinct thermal profile for TB-TTI, differentiating it from DTPI. This work will add to much needed scientific knowledge and will enable clinicians to identify TB-TTIs and validate their assessments with a simple, objective, quantitative, non-invasive, and easy to use screening tool, particularly beneficial for darkly pigmented skin tones.