{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:11:20Z","timestamp":1790334680057,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    This study examines factors associated with deep tissue pressure injury and develops interpretable machine learning models for early risk prediction in adult\n                    <jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content>\n                    patients. This retrospective observational cohort study included 336 adult intensive care unit patients, of whom 211 developed deep tissue pressure injury and 125 remained pressure injury\u2010free. For patients who developed deep tissue pressure injury, haemodynamic, laboratory and nursing variables from the 24\u2009h before injury onset were analysed using a physiological time\u2010at\u2010risk framework. For pressure injury\u2010free patients, corresponding variables from the first 24\u2009h after intensive care unit admission were used. Six supervised machine learning classifiers were developed and internally validated using cross\u2010validation and hyperparameter optimization. All models showed good predictive performance. Extreme gradient boosting achieved the highest discriminative ability, with an area under the receiver operating characteristic curve of 0.976. The most influential predictors across feature selection methods were low\u2010molecular\u2010weight heparin use, norepinephrine duration, lower blood pressure values, immobility, nutritional risk, antiplatelet therapy and chronic disease profile. Routinely documented nursing and haemodynamic indicators obtained within a clinically relevant 24\u2010h risk window can support accurate early risk stratification for deep tissue pressure injury in adult intensive care unit patients. A physiology\u2010informed and interpretable machine learning approach may improve recognition of patients at imminent risk.\n                  <\/jats:p>","DOI":"10.1111\/iwj.71025","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T02:08:51Z","timestamp":1789438131000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Detection of Deep Tissue Pressure Injury in Intensive Care Using Hemodynamics\u2010Based Machine Learning: A Retrospective Cohort Study"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6253-2016","authenticated-orcid":false,"given":"Tuba","family":"Sengul","sequence":"first","affiliation":[{"name":"School of Nursing Ko\u00e7 University  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7544-5974","authenticated-orcid":false,"given":"Beren","family":"Semiz","sequence":"additional","affiliation":[{"name":"Department of Electrical and Electronics Engineering Ko\u00e7 University  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7676-0167","authenticated-orcid":false,"given":"Emre","family":"Gursoy","sequence":"additional","affiliation":[{"name":"Department of Computer Engineering Ko\u00e7 University  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7991-3176","authenticated-orcid":false,"given":"Dilek","family":"Yilmaz Akyaz","sequence":"additional","affiliation":[{"name":"Graduate School of Health Sciences Ko\u00e7 University  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3032-0728","authenticated-orcid":false,"given":"Ayten Dilara","family":"Yavuz","sequence":"additional","affiliation":[{"name":"Department of Computer Engineering Ko\u00e7 University  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0222-9234","authenticated-orcid":false,"given":"Yunus Emre","family":"Akyol","sequence":"additional","affiliation":[{"name":"Ko\u00e7 University Hospital  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4406-7221","authenticated-orcid":false,"given":"Yusuf","family":"Ali","sequence":"additional","affiliation":[{"name":"Ko\u00e7 University Hospital  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1609-0528","authenticated-orcid":false,"given":"Tugba","family":"Cevizci","sequence":"additional","affiliation":[{"name":"Ko\u00e7 University Hospital  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8519-2251","authenticated-orcid":false,"given":"Orhan","family":"Zeytun","sequence":"additional","affiliation":[{"name":"Ko\u00e7 University Hospital  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8844-0331","authenticated-orcid":false,"given":"Violeta","family":"Lopez","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery University of Technology Sydney  Ultimo Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9092-9088","authenticated-orcid":false,"given":"Holly","family":"Kirkland\u2010Kyhn","sequence":"additional","affiliation":[{"name":"Betty Irene Moore School of Nursing UC Davis  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13667"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13711"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1131270"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.2110"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/WON.0000000000000834"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ASW.0000000000000143"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/ASW.0000000000000105"},{"issue":"2","key":"e_1_2_13_9_1","first-page":"42","article-title":"A Retrospective, Descriptive, Comparative Study to Identify Patient Variables That Contribute to the Development of Deep Tissue Injury Among Patients in Intensive Care Units","volume":"63","author":"Kirkland\u2010Kyhn H.","year":"2017","journal-title":"Ostomy\/Wound Management"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591\u2010020\u20100789\u20104"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2024.103686"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/nursrep15040126"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.70038"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13078"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.2196\/28765"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57020177"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.14280"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13764"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.17367"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/jnu.13001"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.2147\/RMHP.S297838"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2022.e11361"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040296"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102020\u2010048008"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1072"},{"key":"e_1_2_13_26_1","volume-title":"Prevention and Treatment of Pressure Ulcers\/Injuries: Clinical Practice Guideline","author":"European Pressure Ulcer Advisory Panel","year":"2019"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_2_13_28_1","first-page":"2825","article-title":"Scikit\u2010Learn: Machine Learning in Python","volume":"12","author":"Pedregosa F.","year":"2011","journal-title":"Journal of Machine Learning Research"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-00296-0_5"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00116251"},{"key":"e_1_2_13_31_1","first-page":"388","volume-title":"Proceedings of the 7th IEEE International Conference on Tools with Artificial Intelligence","author":"Liu H.","year":"1995"},{"key":"e_1_2_13_32_1","first-page":"266","volume-title":"Proceedings of the Twenty\u2010Seventh Conference on Uncertainty in Artificial Intelligence","author":"Gu Q.","year":"2011"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnc.2020.08.008"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2021.103932"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/CIN.0000000000000604"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2018525"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12911\u2010021\u201001608\u20105"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2025.105127"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.3390\/app142210532"},{"key":"e_1_2_13_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-99-0405-1_7"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/NNR.0000000000000245"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18\u20101376"},{"key":"e_1_2_13_44_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmedt.2022.926667"},{"key":"e_1_2_13_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.abd.2025.501187"},{"issue":"2","key":"e_1_2_13_46_1","first-page":"122","article-title":"Assessing Predictive Validity of Pressure Ulcer Risk Scales: A Systematic Review and Meta\u2010Analysis","volume":"45","author":"Park S. H.","year":"2016","journal-title":"Iranian Journal of Public Health"},{"key":"e_1_2_13_47_1","doi-asserted-by":"publisher","DOI":"10.4037\/ccn2020874"},{"key":"e_1_2_13_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2012.11.019"},{"key":"e_1_2_13_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14666"},{"key":"e_1_2_13_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006681.pub4"},{"key":"e_1_2_13_51_1","doi-asserted-by":"publisher","DOI":"10.5334\/egems.307"}],"container-title":["International Wound Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.71025","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iwj.71025","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.71025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T10:54:27Z","timestamp":1790333667000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iwj.71025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":50,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/iwj.71025"],"URL":"https:\/\/doi.org\/10.1111\/iwj.71025","archive":["Portico"],"relation":{},"ISSN":["1742-4801","1742-481X"],"issn-type":[{"value":"1742-4801","type":"print"},{"value":"1742-481X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-04-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71025"}}