Comparison of Bone Age Assessments by Gruelich-Pyle, Gilsanz-Ratib, and Tanner Whitehouse Methods in Healthy Indian Children

Shah, Nikhil; Khadilkar, Vaman; Lohiya, Nikhil; Prasad, Hemchand Krishna; Patil, Prashant H.; Gondhalekar, Ketan; Khadilkar, Anuradha

doi:10.4103/ijem.ijem_826_20

Cited by 13 publications

(15 citation statements)

References 25 publications

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“…Eng et al11 similarly reported an MAD of 5.95 months with a 95% confidence interval of 5.53 to 6.37 months. The variability of other well-known and accepted comprehensive methods are similar, with root mean squares of 1.21, 1.18, and 1.11 years between the chronologic age and the GP method bone age, Gilsanz and Ratib atlas bone age, and Tanner-Whitehouse 3 method bone age, respectively 12…”

Section: Discussionmentioning

confidence: 69%

“…Eng et al 11 similarly reported an MAD of 5.95 months with a 95% confidence interval of 5.53 to 6.37 months. The variability of other well-known and accepted 12 All currently available bone age methods are limited to varying extents by their variability. Abbreviated methods are no exceptions and are also hampered by the comprehensive methods to which they are compared.…”

Section: Discussionmentioning

confidence: 99%

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A Comparison of 2 Abbreviated Methods for Assessing Adolescent Bone Age: The Shorthand Bone Age Method and the SickKids/Columbia Method

Bixby¹,

Skaggs²,

Berube³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Radiographic assessment of bone age is critically important to decision-making on the type and timing of operative interventions in pediatric orthopaedics. The current widely accepted method for determining bone age is time and resourceintensive. This study sought to assess the reliability and accuracy of 2 abbreviated methods, the Shorthand Bone Age (SBA) and the SickKids/Columbia (SKC) methods, to the widely accepted Greulich and Pyle (GP) method. Methods: Standard posteroanterior radiographs of the left hand of 125 adolescent males and 125 adolescent females were compiled, with bone ages determined by the GP method ranging from 9 to 16 years for males and 8 to 14 years for females. Blinded to the chronologic age and GP bone age of each child, the bone age for each radiograph was determined using the SBA and SKC methods by an orthopaedic surgery resident, 2 pediatric orthopaedic surgeons, and a musculoskeletal radiologist. Measurements were then repeated 2 weeks later after rerandomization of the radiographs. Intrarater and interrater reliability for the 2 abbreviated methods as well as the agreement between all 3 methods were calculated using weighted κ values. Mean absolute differences between methods were also calculated. Results: Both bone age methods demonstrated substantial to almost perfect intrarater reliability, with a weighted κ ranging from 0.79 to 0.93 for the SBA method and from 0.82 to 0.96 for the SKC method. Interrater reliability was moderate to substantial (weighted κ: 0.55 to 0.84) for the SBA method and substantial to almost perfect (weighted κ: 0.67 to 0.92) for the SKC method.Agreement between the 3 methods was substantial for all raters and all comparisons. The mean absolute difference, been GP-derived and SBA-derived bone age, was 7.6 ± 7.8 months, as compared with 8.8 ± 7.4 months between GP-derived and SKC-derived bone ages. Conclusions: The SBA and SKC methods have comparable reliability, and both correlate well to the widely accepted GP methods and to each other. However, they have relatively large absolute differences when compared with the GP method. These methods offer simple, efficient, and affordable estimates for bone age determination, but at best provide an estimate to be used in the appropriate setting. Level of Evidence: Diagnostic study-level III.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

A Comparison of 2 Abbreviated Methods for Assessing Adolescent Bone Age: The Shorthand Bone Age Method and the SickKids/Columbia Method

Bixby¹,

Skaggs²,

Berube³

et al. 2022

Journal of Pediatric Orthopaedics

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“…Although the GP atlas is one of the most commonly utilized atlases for bone age, others advocate for the use of the Tanner-Whitehouse method due to its accuracy and reproducibility 17,18 . A major limitation of the Tanner-Whitehouse system is the clinical burden due to the large number of parameters, with 1 study estimating 7.9 minutes to implement the Tanner-Whitehouse compared with 1.4 minutes to implement the GP system 19 .…”

Section: Discussionmentioning

confidence: 99%

The Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on Lateral Elbow Radiographs

Sinkler

Furdock

Chen

et al. 2022

Journal of Bone and Joint Surgery

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Background: Skeletal maturity estimation is central in the management of scoliosis and lower-limb deformity. Utilizing demographic characteristics and modern computing, we sought to create a reliable, rapid, and accurate method for measuring skeletal maturity on an elbow radiograph.Methods: Utilizing the Bolton-Brush Collection, 4 parameters from the modified Sauvegrain method and 7 novel parameters were screened. Ten parameters were evaluated on serial peripubertal elbow radiographs, using Greulich and Pyle (GP) skeletal age from corresponding hand radiographs as a comparison. Stepwise linear regression and generalized estimating equations were used to identify radiographic and demographic parameters for estimating skeletal maturity based on 90% of final height. The elbow system was compared with GP only; olecranon apophysis only; age, sex, and GP; age, sex, and olecranon apophysis; age, sex, and elbow system with anteroposterior and lateral parameters; age, sex, and elbow system with anteroposterior parameters; and age, sex, and elbow system with lateral parameters.Results: In this study, 367 radiographs from 77 patients (40 girls and 37 boys) were included. Following stepwise linear regression, 4 radiographic parameters were included in the anteroposterior and lateral elbow system; 3 were included in the anteroposterior elbow system; and 4 were included in the lateral elbow system. The lateral elbow system predicted skeletal maturity with a mean discrepancy of 0.41 year and produced similar mean discrepancies to GP with age and sex (0.42; p = 0.93), and it trended toward better performance than the olecranon apophysis system with age and sex (0.43; p = 0.06). The lateral elbow system had the lowest percent of outlier predictions >1 year discrepant from the skeletal maturity reference (4.6%), although it was only significantly better than the GP-only group (29.4%) and the olecranon apophysis-only group (21.0%) (p < 0.001 for both). Conclusions:We systematically developed a lateral elbow system that performed equivalently to GP using 4 simple parameters and trended toward outperforming the olecranon apophysis systems in skeletal maturity estimation. Future clinical validation will be necessary to understand the utility of this system.Clinical Relevance: The lateral elbow system may be a more accurate prediction of skeletal maturity compared with the previously described olecranon apophysis system and can be used to guide the management of many pediatric orthopaedic conditions.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H200).

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“…Both observers were blinded to the chronological age of the child. The same set of radiographs were analysed earlier by a set of four experienced observers (published earlier) and the means of their reported bone ages (for GP, TW2, TW3) were used as ground truth for comparison with the new method (mean of VK and SM) [11]. Deidenti ed radiographs of children aged 0-18 years from a previous dataset were used [11].…”

Section: Methodsmentioning

confidence: 99%

Development of a simplified new method of bone age estimation using three bones of the hand and wrist

Khadilkar,

Mondkar,

Desai

et al. 2024

Endocrine

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Though the Greulich and Pyle(GP) method is easy, inter-observer variability, differential maturation of hand bones in uences ratings. The Tanner-Whitehouse(TW) method is more accurate, but cumbersome.A simpler method combining the above, such that it utilizes fewer bones without affecting accuracy, would be widely used and more applicable in clinical practice.Objectives:1.Devising a simpli ed method utilizing three bones of the hand and wrist for bone age(BA) assessment.2.Testing whether the 3 bone method gives comparable results to standard methods (GP,TW2,TW3) in Indian children.Methods:Developmental stages and corresponding BA for radius, hamate, terminal phalanx (left middle nger) epiphyses combining stages from GP,TW3 atlases were described; BA were rated by two blinded observers. 3 bone method ratings were compared with the same dataset analyzed earlier using GP,TW2,TW3(4 raters).

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Comparison of Bone Age Assessments by Gruelich-Pyle, Gilsanz-Ratib, and Tanner Whitehouse Methods in Healthy Indian Children

Cited by 13 publications

References 25 publications

A Comparison of 2 Abbreviated Methods for Assessing Adolescent Bone Age: The Shorthand Bone Age Method and the SickKids/Columbia Method

A Comparison of 2 Abbreviated Methods for Assessing Adolescent Bone Age: The Shorthand Bone Age Method and the SickKids/Columbia Method

The Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on Lateral Elbow Radiographs

Development of a simplified new method of bone age estimation using three bones of the hand and wrist

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