Reliability of Schmeling’s stages of ossification of medial clavicular epiphyses and its validity to assess 18 years of age in living subjects

Abstract

Nowadays, due to the global increase in migration movements, forensic age estimation of living young adults has become an important focus of interest. Minors often have no identification documents providing their correct birth dates. Establishing the age of majority is therefore fundamental in order to determine whether juvenile penal systems or penal systems in force for adults are to be applied. Radiological examination of the clavicles is one of the methods recommended by the Study Group on Forensic Age Diagnostics. In this retrospective study, a sample of chest radiographs of 274 subjects, aged between 12 and 25 years, was studied according to Schmeling's method in order to examine the ossification of both medial clavicular epiphyses. All stage classifications were evaluated by five examiners. Intra- and inter-examiner reliability was analysed by Cohen's K statistic. Intra-examiner agreement was insufficient for two of the experts. Inter-examiner agreement, among the other three operators, was moderate (K = 0.509). Study of reliability highlighted difficulties in interpretation, the need to select qualified personnel and choice of the best radiographic image in order to reduce any anatomic overlaps. Although ossification of the medial clavicular epiphyses is recommended to assess whether an individual has already reached the age of majority or not, these results suggested that it is very difficult to clearly identify the five stages of ossification by using conventional chest radiography.

Estimation of forensic age using substages of ossification of the medial clavicle in living individuals

“…Work on age-staging ossification of the medial clavicular bone has attracted particular intention; assessments may be made by X-ray [3,4], CT [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], ultrasonography [18,21,22], or magnetic resonance imaging [23][24][25]. During the last few years, CT has mainly been performed for research purposes in the forensic sciences; thus, it is recognized that the study of thin sections at high resolution may help eliminate mistakes by allowing more detailed assessments [6,8,10,12].…”

The epiphyseal scar: changing perceptions in relation to skeletal age estimation

“…Comparatively few studies however have examined the validity of methods of age estimation based on specified maturity criteria and staging (Cameriere et al, 2012, O' Connor et al, 2008. The paucity of research relating to the application of such methods raises questions pertaining to the validity of the assumptions on which the maturity criteria are based, including the assumption that those criteria developed in one anatomical region are directly applicable to others (Kellinghaus et al, 2010, Schmeling et al, 2004.…”

A biochemical approach for assessing cutoffs at the age thresholds of 14 and 18 years: a pilot study on the applicability of bone specific alkaline phosphatase on an Italian sample

“…Cameriere et al [56] studied the reliability of Schmeling's stages of ossification of medial clavicular epiphyses and its I II III IV V I II III I II III IV V I II III IV validity to assess 18 years of age in living subjects. All radiographic images were analyzed by five examiners, two specialized forensic anthropologists, two forensic odontologists, and one physician experienced in Schmeling's method.…”