Comparison of two radiological methods in the determination of skeletal maturity in the Indian pediatric population

Abstract

To determine a more precise and reliable method between Greulich-Pyle (GP) and MacKay's (MK) method for the determination of skeletal age in an Indian pediatric population. We carried out a cross sectional study for the assessment of skeletal age on the basis of examination of hand and wrist radiographs of 106 patients (1-15 years of age) who presented with soft tissue injury to hand by the GP and the MK method. These radiographs were evaluated by a radiologist and an orthopedic surgeon independently. In girls, the mean age difference between chronological and skeletal age was 8 months by the GP method, whereas it was 17 months by MK method. For boys, the mean age difference was 10 months by the GP method and by MKs method, it was 20 months. By the GP method, 44% of the boys showed a more reliable estimate of age whereas it was 10% by the MK method. However, the same for girls was 25% by the GP method and 16% by the MK method. The inter-rater reliability for the raters was found to be κ=0.68 and this was statistically significant (P<0.001), 95% confidence interval (0.504-0.848). We concluded that the GP method appeared to be more reliable in the determination of skeletal age in the Indian pediatric population.

Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review

“…Out of the 51 studies, 21 (41.18%) were conducted in different regions of Asia. Specifically, five studies were conducted in India [35][36][37][38][39], four in Turkey [40][41][42][43], three in Pakistan [30,44,45], two each in Saudi Arabia [46,47], China [48,49], and South Korea [50,51], and one each in Taiwan [52], Iran [53], and Israel [54].…”

“…Regarding study design, 25 (49.02%) were observational retrospective cohort studies [23,35,40,42,43,48,50,52,54,55,57,58,[61][62][63][64][65][66][67][68][69]76,79,83,84], followed by 19 (37.25%) crosssectional studies [30,[36][37][38][44][45][46]51,53,59,60,[72][73][74][75]77,78,81,82], and 7 (13.73%) observational prospective cohort studies [39,41,55,56,70,71,80].…”

“…Additionally, five studies (9.80%) were conducted exclusively in Africa, including two in South Africa [71,72], one in Zimbabwe [73] one in Botswana [74], and one in A total of 30 papers (58.8%) studied the accuracy [23,[35][36][37]40,41,43,45,48,49,[51][52][53]55,57,59,[64][65][66]69,70,[72][73][74][76][77][78][79][80]82], 1 of which also separately calculated the sensitivity and specificity [62]. A total of 27 (52.94%) studies analyzed precision [35,36,42,44,46,47,50,52,[56][57][58][60][61][62]…”

“…Secondly, the number of radiographs in studies conducted on Asian children was n = 3097 (15.40%). Of these studies, one subset focused specifically on Asian children (n = 2366, 11.77%) [23,[47][48][49][50][51][52]80], while another subset focused on Indian (n = 731, 3.63%) [35][36][37][38][39] and Indonesian children [78,79].…”

“…Regarding the radiological skeletal methods, 92.2% of included studies used the manually applied Greulich and Pyle (GPA) method (n = 47) [23,[35][36][37][39][40][41]83] followed by the Tanner-Whitehouse-3 method (n = 9) [38,[47][48][49][50][51]55,62,73] and Tanner-Whitehouse-2 (n = 4) [56,59,62,70] Radiological dental procedures for BA assessment included Demirjian's classification system [36,42,63,64,81], the FELS method [60], and the evaluation of cervical vertebra maturation (CVM), described by Mito et al [38,42].…”