An Improved Method for Developing Injury Risk Curves Using the Brier Metric Score
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Annals of Biomedical Engineering (Ó 2020) https://doi.org/10.1007/s10439-020-02686-8
WIAMan Biomechanics
An Improved Method for Developing Injury Risk Curves Using the Brier Metric Score ZACHARY S. HOSTETLER,1 FANG-CHI HSU,2 NARAYAN YOGANANDAN,3 FRANK A. PINTAR,3 ANJISHNU BANERJEE,4 LIMING VOO,5 and F. SCOTT GAYZIK1 1 Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Avenue, Winston-Salem, NC 27101, USA; Biostatistics and Data Science, Wake Forest School of Medicine, 525 Vine St., Winston-Salem, NC 27101, USA; 3Department of Neurosurgery, Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA; 4Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA; and 5Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
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(Received 1 June 2020; accepted 4 November 2020) Associate Editor Stefan M. Duma oversaw the review of this article.
Abstract—Many injury metrics are routinely proposed from measured or derived quantities from biomechanical experiments using post mortem human subjects (PMHS). The existing literature did not provide guidance on deciding between parameters collected in an experiment that would be best to use for the development of human injury probability curves (HIPC). The objective of this study was to use the Brier Metric Score (BMS) to identify the most appropriate metric from an experiment that predicts injury outcomes. The Brier Metric Score assesses how well a metric predicts the outcome for a censored data point (a lower BMS is better). Survival analysis was then conducted with the selected metric and the best distribution was selected using Akaike information criterion (AIC). Confidence intervals (CIs) and the normalized confidence interval width (NCIS) were calculated for the injury probability curve. The testing and validation of the methods described were performed using biomechanics data in the open literature. The methods for the HIPC development procedure detailed herein have been rigorously tested and used in the generation of WIAMan HIPCs and Injury Assessment Reference Curves (IARCs) for the WIAMan ATD, but can also be used in other ATD or PMHS injury risk curve development. Keywords—Injury probability curve, Brier Metric Score, Survival analysis, Injury biomechanics, Military.
Address correspondence to F. Scott Gayzik, Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Avenue, Winston-Salem, NC 27101, USA. Electronic mail: sgayzik@ wakehealth.edu
INTRODUCTION Injury probability curves are an important assessment tool that can be derived from biomechanical experiments using post mortem human subjects (PMHS), animal tests, human volunteer tests, and more recently computational studies. In the military and automotive environment, PMHS tests have been conducted to improve safety for the lower extremity, pelvis, and cervical spine.1,21,23,27 Traumatic brain injury (TBI) has been studied in animal testing and resulted in injury risk curves for head impacts in sports and military applications as well.9,19 Add
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