Defining Trombley-Brennan Terminal Tissue Injury With Long-Wave Infrared Thermography

OBJECTIVE: To determine whether long-wave infrared thermography (LWIT) can identify a unique thermal signature for Trombley-Brennan terminal tissue injury (TB-TTI) and to distinguish its thermal characteristics from deep tissue pressure injury (DTPI). 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 preexisting PIs, were eligible. Infrared thermographic imaging was performed using the LWIT 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 <.0001), maximum (−1.77 vs. 0.52, P =.0434), and minimum (−1.85 vs. −0.22, P =.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 =.0011) compared with the adjacent tissue. No significant differences were observed in wound size or perimeter. CONCLUSIONS: LWIT successfully identified a distinct thermal profile for TB-TTI, differentiating it from DTPI. These findings support the use of LWIT as a noninvasive, objective tool for accurate identification of TB-TTI, particularly in patients with dark skin tones. The technique has the potential to improve prognostication, reduce misclassification, and guide care for end-of-life patients.