FT-ARM: Fine-Tuned Agentic Reflection Multimodal Language Model for Pressure Ulcer Severity Classification with Reasoning

TL;DR

FT-ARM is a multimodal language model with iterative reasoning and self-reflection that improves pressure ulcer severity classification accuracy and interpretability, supporting real-time clinical decision-making.

Contribution

It introduces FT-ARM, a fine-tuned multimodal language model with agentic reflection for pressure ulcer staging, enhancing accuracy and interpretability over prior CNN and ViT methods.

Findings

Achieved 85% accuracy on PIID, surpassing prior models by 4%.

Provides natural-language explanations for clinical predictions.

Designed for live inference, suitable for real-time clinical use.

Abstract

Pressure ulcers (PUs) are a serious and prevalent healthcare concern. Accurate classification of PU severity (Stages I-IV) is essential for proper treatment but remains challenging due to subtle visual distinctions and subjective interpretation, leading to variability among clinicians. Prior AI-based approaches using Convolutional Neural Networks (CNNs) and Vision Transformers (ViTs) achieved promising accuracy but offered limited interpretability. We present FT-ARM (Fine-Tuned Agentic Reflection Multimodal model), a fine-tuned multimodal large language model (MLLM) with an agentic self-reflection mechanism for pressure ulcer severity classification. Inspired by clinician-style diagnostic reassessment, FT-ARM iteratively refines its predictions by reasoning over visual features and encoded clinical knowledge from text, enhancing both accuracy and consistency. On the publicly available Pressure Injury Image Dataset (PIID), FT-ARM, fine-tuned from LLaMA 3.2 90B, achieved 85% accuracy in classifying PU stages I-IV, surpassing prior CNN-based models by +4%. Unlike earlier CNN/ViT studies that relied solely on offline evaluations, FT-ARM is designed and tested for live inference, reflecting real-time deployment conditions. Furthermore, it produces clinically grounded natural-language explanations, improving interpretability and trust. By integrating fine-tuning and reflective reasoning across multimodal inputs, FT-ARM advances the reliability, transparency, and clinical applicability of automated wound assessment systems, addressing the critical need for consistent and explainable PU staging to support improved patient care.