{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T21:28:52Z","timestamp":1786397332390,"version":"build-2736575974"},"reference-count":43,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Inform"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pressure injury (PI) can cause severe infections or death, and has a high global prevalence. Accurate staging is vital for effective intervention. Deep learning streamlines PI assessment; enhances efficiency; and yields practical, accurate results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The primary objective of this scoping review was to map the landscape of deep learning applications for PI identification and categorize the existing body of evidence into distinct technological trajectories: unimodal imaging and multimodal integration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched the following databases and sources: PubMed, the Cochrane Library, IEEE Xplore, and Web of Science. This scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 15 articles were included: 40% (n=6) studies applied multimodal integration, whereas 60% (n=9) applied unimodal imaging. In total, 26 models were involved. Different models exhibited varying accuracy rates in staging PI, with overall accuracy fluctuating between 54.8% and 93.7%. The same model demonstrated significant variations in recognition accuracy across different studies. Multimodal integration appeared to be a distinguishing characteristic of the studies that will progress toward clinical validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The current landscape of deep learning in PI identification is heavily skewed toward unimodal imaging, creating a modality gap that hinders clinical translation. While unimodal models demonstrate high accuracy in controlled settings, future research must prioritize bridging the gap from unimodal imaging to true multimodal integration to achieve clinical-grade reliability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/91048","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T22:55:07Z","timestamp":1784156107000},"page":"e91048-e91048","source":"Crossref","is-referenced-by-count":0,"title":["Unimodal and Multimodal Deep Learning for Pressure Injury Identification: Scoping Review"],"prefix":"10.2196","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0079-9429","authenticated-orcid":false,"given":"Yingxue","family":"Sun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0031-614X","authenticated-orcid":false,"given":"Congcong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7438-0126","authenticated-orcid":false,"given":"Ji-cheng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6295-0329","authenticated-orcid":false,"given":"Zhengang","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6259-5682","authenticated-orcid":false,"given":"Zhenfeng","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1832-9256","authenticated-orcid":false,"given":"Chunmei","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7846-7653","authenticated-orcid":false,"given":"Fangyan","family":"Yue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"issue":"6","key":"R1","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1046\/j.1365-2834.1999.00135.x","article-title":"Promoting evidence-based practice: managing change in the assessment of pressure damage risk","volume":"7","author":"Gerrish","journal-title":"J Nurs Manag"},{"issue":"6","key":"R2","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1097\/WON.0000000000000281","article-title":"Revised National Pressure Ulcer Advisory Panel pressure injury staging system: revised pressure injury staging system","volume":"43","author":"Edsberg","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2020.103546","article-title":"Global prevalence and incidence of pressure injuries in hospitalised adult patients: a systematic review and meta-analysis","volume":"105","author":"Li","journal-title":"Int J Nurs Stud"},{"issue":"2","key":"R4","doi-asserted-by":"publisher","DOI":"10.1111\/ijn.13041","article-title":"Effectiveness and safety of electrical stimulation for treating pressure ulcers: a systematic review and meta-analysis","volume":"29","author":"Chen","journal-title":"Int J Nurs Pract"},{"issue":"3","key":"R5","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.jtv.2020.04.003","article-title":"Pressure ulcer\/injury classification today: an international perspective","volume":"29","author":"Kottner","journal-title":"J Tissue Viability"},{"issue":"3","key":"R6","doi-asserted-by":"publisher","first-page":"1556","DOI":"10.1002\/nop2.1406","article-title":"The ability of critical care nurses to identify pressure injury and incontinence-associated dermatitis: a multicentre cross-sectional survey","volume":"10","author":"Liu","journal-title":"Nurs Open"},{"issue":"7","key":"R7","doi-asserted-by":"publisher","first-page":"9241","DOI":"10.1109\/TPAMI.2022.3231725","article-title":"Patch-based separable transformer for visual recognition","volume":"45","author":"Sun","journal-title":"IEEE Trans Pattern Anal Mach Intell"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1109\/TPAMI.2018.2798607","article-title":"Multimodal machine learning: a survey and taxonomy","volume":"41","author":"Baltrusaitis","journal-title":"IEEE Trans Pattern Anal Mach Intell"},{"issue":"4","key":"R9","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.14565","article-title":"Development of an explainable artificial intelligence model for Asian vascular wound images","volume":"21","author":"Lo","journal-title":"Int Wound J"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2025.109014","article-title":"A comprehensive review of techniques, algorithms, advancements, challenges, and clinical applications of multi-modal medical image fusion for improved diagnosis","volume":"272","author":"Zubair","journal-title":"Comput Methods Programs Biomed"},{"issue":"12","key":"R11","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1089\/wound.2021.0091","article-title":"Image-based artificial intelligence in wound assessment: a systematic review","volume":"11","author":"Anisuzzaman","journal-title":"Adv Wound Care (New Rochelle)"},{"issue":"4","key":"R12","doi-asserted-by":"publisher","first-page":"229","DOI":"10.12968\/jowc.2024.33.4.229","article-title":"Artificial intelligence in wound care: diagnosis, assessment and treatment of hard-to-heal wounds: a narrative review","volume":"33","author":"Rippon","journal-title":"J Wound Care"},{"issue":"7","key":"R13","doi-asserted-by":"publisher","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation","volume":"169","author":"Tricco","journal-title":"Ann Intern Med"},{"issue":"10","key":"R14","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.11124\/JBIES-20-00167","article-title":"Updated methodological guidance for the conduct of scoping reviews","volume":"18","author":"Peters","journal-title":"JBI Evid Synth"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.2196\/62774","article-title":"Convolutional neural network models for visual classification of pressure ulcer stages: cross-sectional study","volume":"13","author":"Lei","journal-title":"JMIR Med Inform"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1109\/MMUL.2024.3524427","article-title":"Detection and diagnosis for pressure injury by using SE-Swin Cascade R-CNN","volume":"32","author":"Huang","journal-title":"IEEE MultiMed"},{"issue":"7","key":"R17","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000041530","article-title":"Development of a pressure ulcer stage determination system for community healthcare providers using a vision transformer deep learning model","volume":"104","author":"Cho","journal-title":"Medicine (Baltimore)"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/67356","article-title":"Fine-grained classification of pressure ulcers and incontinence-associated dermatitis using multimodal deep learning: algorithm development and validation study","volume":"4","author":"Brehmer","journal-title":"JMIR AI"},{"issue":"3","key":"R19","doi-asserted-by":"publisher","first-page":"262","DOI":"10.33160\/yam.2025.08.014","article-title":"Improving the accuracy of diagnostic imaging using artificial intelligence: a method for assessing necrotic tissue in pressure injury","volume":"68","author":"Kimura","journal-title":"Yonago Acta Med"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2024.1304829","article-title":"A novel deep-learning based weighted feature fusion architecture for precise classification of pressure injury","volume":"15","author":"Wang","journal-title":"Front Physiol"},{"issue":"4","key":"R21","doi-asserted-by":"publisher","first-page":"609","DOI":"10.62713\/aic.3502","article-title":"Enhancing diagnostic accuracy with SE-Inception model integration in pressure ulcer detection","volume":"95","author":"Gui","journal-title":"Ann Ital Chir"},{"issue":"2","key":"R22","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1007\/s10278-023-00960-4","article-title":"Region-based semi-two-stream convolutional neural networks for pressure ulcer recognition","volume":"37","author":"Zalluho\u011flu","journal-title":"J Imaging Inform Med"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/3858997","article-title":"Simultaneous segmentation and classification of pressure injury image data using Mask-R-CNN","volume":"2023","author":"Swerdlow","journal-title":"Comput Math Methods Med"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2023.105266","article-title":"Augmented decision-making in wound care: evaluating the clinical utility of a deep-learning model for pressure injury staging","volume":"180","author":"Kim","journal-title":"Int J Med Inform"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2023.3289839","article-title":"Pressure ulcer categorization and reporting in domiciliary settings using deep learning and mobile devices: a clinical trial to evaluate end-to-end performance","volume":"11","author":"Fergus","journal-title":"IEEE Access"},{"issue":"8","key":"R26","doi-asserted-by":"publisher","first-page":"3047","DOI":"10.1111\/jan.15584","article-title":"Visual classification of pressure injury stages for nurses: a deep learning model applying modern convolutional neural networks","volume":"79","author":"Seo","journal-title":"J Adv Nurs"},{"issue":"9","key":"R27","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11091222","article-title":"YOLO-based deep learning model for pressure ulcer detection and classification","volume":"11","author":"Aldughayfiq","journal-title":"Healthcare (Basel)"},{"issue":"11","key":"R28","doi-asserted-by":"publisher","first-page":"2227","DOI":"10.1016\/j.jfma.2022.04.010","article-title":"A pressure ulcers assessment system for diagnosis and decision making using convolutional neural networks","volume":"121","author":"Liu","journal-title":"J Formos Med Assoc"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1007\/s00521-022-07274-6","article-title":"Deep transfer learning-based visual classification of pressure injuries stages","volume":"34","author":"Ay","journal-title":"Neural Comput Appl"},{"issue":"6","key":"R30","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1145\/3065386","article-title":"ImageNet classification with deep convolutional neural networks","volume":"60","author":"Krizhevsky","journal-title":"Commun ACM"},{"issue":"4","key":"R31","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1109\/TPAMI.2016.2572683","article-title":"Fully convolutional networks for semantic segmentation","volume":"39","author":"Shelhamer","journal-title":"IEEE Trans Pattern Anal Mach Intell"},{"issue":"4","key":"R32","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1109\/TMI.2016.2642839","article-title":"Automated melanoma recognition in dermoscopy images via very deep residual networks","volume":"36","author":"Yu","journal-title":"IEEE Trans Med Imaging"},{"issue":"5","key":"R33","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1109\/TMI.2018.2878669","article-title":"HyperDense-Net: a hyper-densely connected CNN for multi-modal image segmentation","volume":"38","author":"Dolz","journal-title":"IEEE Trans Med Imaging"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1109\/EMBC44109.2020.9175664","article-title":"Explainable diabetic retinopathy using EfficientNET","volume":"2020","author":"Chetoui","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"},{"issue":"8","key":"R35","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.1016\/j.burns.2020.07.010","article-title":"Real-time burn depth assessment using artificial networks: a large-scale, multicentre study","volume":"46","author":"Wang","journal-title":"Burns"},{"issue":"1","key":"R36","doi-asserted-by":"publisher","DOI":"10.1186\/s12880-020-00530-y","article-title":"Universal adversarial attacks on deep neural networks for medical image classification","volume":"21","author":"Hirano","journal-title":"BMC Med Imaging"},{"issue":"1","key":"R37","doi-asserted-by":"publisher","DOI":"10.1186\/s12880-025-01941-5","article-title":"Assessing inter-rater reliability of MRI features in glioma: a multi-radiologist agreement study","volume":"25","author":"Mohebbi","journal-title":"BMC Med Imaging"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2025.110525","article-title":"Classifying the clinical significance of common breast pain symptoms using a large language model, ChatGPT (GPT-4)","volume":"125","author":"Haver","journal-title":"Clin Imaging"},{"issue":"9","key":"R39","doi-asserted-by":"publisher","first-page":"1904","DOI":"10.1109\/TPAMI.2015.2389824","article-title":"Spatial pyramid pooling in deep convolutional networks for visual recognition","volume":"37","author":"He","journal-title":"IEEE Trans Pattern Anal Mach Intell"},{"issue":"5","key":"R40","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1097\/01.ASW.0000554444.52120.f6","article-title":"Professionals\u2019 knowledge, attitudes, and practices related to pressure injuries in Canada","volume":"32","author":"LeBlanc","journal-title":"Adv Skin Wound Care"},{"issue":"2","key":"R41","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1089\/wound.2016.0697","article-title":"Review of the current management of pressure ulcers","volume":"7","author":"Boyko","journal-title":"Adv Wound Care (New Rochelle)"},{"issue":"5","key":"R42","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.7150\/thno.105109","article-title":"Current status, challenges, and prospects of artificial intelligence applications in wound repair theranostics","volume":"15","author":"Liu","journal-title":"Theranostics"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2024.108689","article-title":"Integrating AI-driven wearable devices and biometric data into stroke risk assessment: a review of opportunities and challenges","volume":"249","author":"Olawade","journal-title":"Clin Neurol Neurosurg"}],"container-title":["JMIR Medical Informatics"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T20:53:16Z","timestamp":1786395196000},"score":1,"resource":{"primary":{"URL":"https:\/\/medinform.jmir.org\/2026\/1\/e91048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":43,"URL":"https:\/\/doi.org\/10.2196\/91048","relation":{},"ISSN":["2291-9694"],"issn-type":[{"value":"2291-9694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"article-number":"v14i6e91048"}}