A systematic review of ultrasound imaging as a relevant approach for the early detection of pressure injuries in at risk patients

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Hicks, Benjamin and Osuagwu, Bethel and Miller, Jennifer and Buis, Arjan and Mulvana, Helen (2026) A systematic review of ultrasound imaging as a relevant approach for the early detection of pressure injuries in at risk patients. British Journal of Radiology. ISSN 0007-1285 (https://doi.org/10.1093/bjr/tqag121)

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Abstract

Objectives Deep tissue injury (DTI) presents a damage pathway to severe pressure injury (PI) that is invisible to standard visual skin assessment (VSA) techniques, but is visible to ultrasound imaging. This systematic review aimed to compare the diagnostic accuracy of ultrasound imaging to the standard VSA techniques using Meta-Analyses of the literature Methods This systematic review used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results This review identified n = 7 studies that reported using ultrasound to image known PI and identified the Hypoechoic Lesion (HL) to be the most reliably identified ultrasound feature associated with PI presentation. Meta-analysis for the HL feature produced a pooled sensitivity and specificity of 86% (5% CrI 58–97%) and 89% (95% CrI 56–96%), respectively. The diagnostic odds ratio was found to be 45.67 (95% CrI 4.54–328.67), and the positive and negative likelihood ratios, respectively, were recorded as 7.24 (CrI 1.80–19.74) and 0.165 (CrI 0.037–0.51) Conclusions These data suggest that ultrasound has good sensitivity and specificity for identifying PI in this limited sample size, and that ultrasound imaging may hold value for early detection of PI/DTI while VSA appears less suited to the detection of deep tissue damage. Our findings indicate that further assessment of standardised ultrasound imaging protocols and classification systems may enable future improvements in PI detection. Advancements in knowledge Preliminary measures of detection accuracy of Ultrasound imaging for PI detection across the literature demonstrated a good ability to detect PI. This suggests that a standardised protocol for ultrasound diagnosis of PI could provide earlier detection than current VSA standards.

ORCID iDs

Hicks, Benjamin, Osuagwu, Bethel, Miller, Jennifer, Buis, Arjan ORCID logoORCID: https://orcid.org/0000-0003-3947-293X and Mulvana, Helen;
CORE (COnnecting REpositories)