Pressure injuries in critically ill patients present a significant healthcare burden. Traditional methods, such as the Braden score, assess the risk of developing pressure injuries by evaluating factors like sensory perception, moisture and mobility. In contrast, thermographic imaging, which measures variations in skin temperature, offers a promising tool for not only assessing risk but also enabling earlier identification of pressure injuries. This study assessed thermographic imaging's ability to detect existing and evolving pressure injuries in surgical intensive care unit (SICU) patients and compared its accuracy with the Braden score. Among 465 patients, 76 underwent thermographic evaluations of the sacrum and/or heel. Of 25 patients with pressure injuries at admission, 23 had abnormal thermographic scores. Fifteen patient developed pressure injuries during SICU admission. Logistic regression showed that abnormal thermographic scores significantly increased the likelihood of detecting both existing and new injuries, while the Braden score was not a significant predictor. Thermographic imaging appears to be a superior predictor of pressure injuries, offering earlier detection and potentially improving patient outcomes while reducing healthcare costs.