Cross-Contextual Vision-Language Adaptation with LoRA for Personalized Severe Adverse Event Detection in Clinical Wound Monitoring

Wound monitoring is a critical yet underserved clinical challenge, where timely identification of severe adverse events (SAEs) such as infection, tissue deterioration, and delayed healing can significantly impact patient outcomes. While vision-language models (VLMs) show strong multimodal reasoning, they often lack domain-specific grounding to integrate wound imagery with heterogeneous clinical information, and provide limited mechanisms for detecting cases that diverge from the training distribution. We present a multimodal framework for automated wound monitoring and SAE detection. Our approach leverages paired clinical notes and wound descriptions capturing visual characteristics such as appearance, surrounding skin condition, color changes, and signs of inflammation or healing progression, encoded through a dual-stream Low-Rank Adaptation (LoRA) framework built on a frozen BiomedCLIP backbone. We introduce a cross-contextual LoRA fusion mechanism enabling information exchange between clinical semantics and visual wound descriptors, producing context-aware multimodal representations without full model fine-tuning. To identify personalized SAEs, we propose a wound-specific out-of-distribution (OOD) detection framework combining semantic matching, visual typicality, caption-text alignment, and caption-visual alignment into a unified SAE (OOD) score. To capture healing dynamics, we incorporate covariate consistency and temporal drift penalties that leverage changes in wound characteristics across visits. Experiments on a longitudinal wound dataset collected through clinical visits show promising performance on both wound healing assessment and SAE detection, highlighting the potential of semantically enriched, temporally aware vision-language systems for clinical wound monitoring and early risk identification.