Top

European Radiology

Published in:

Open Access 01-06-2019 | Forensic Medicine

Is the Greulich and Pyle atlas applicable to all ethnicities? A systematic review and meta-analysis

Authors: Khalaf Alshamrani, Fabrizio Messina, Amaka C. Offiah

Published in: European Radiology | Issue 6/2019

Abstract

Objective

To determine whether the Greulich and Pyle (G&P) atlas is applicable when applied to populations of different ethnicity.

Methods

A systematic review of studies published between 1959 and 15th February 2017 identified from the Embase, MEDLINE and Cochrane databases was undertaken. Quality of the studies was assessed using the National Institute for Health and Care Excellence tool. Meta-analysis used mean differences and standard deviations as summary statistics for the difference between bone age (BA) and chronological age (CA).

Results

A total of 49 studies were included of which 27 (55%) were related to Caucasian populations. Of the 49 eligible studies, 35 were appropriate for further meta-analysis. In African females, meta-analysis showed a significant mean difference between BA and CA of 0.37 years (95% CI 0.04, 0.69). In Asian males, meta-analysis showed significant differences between BA and CA of -1.08, -1.35, -1.07, -0.80 and 0.50 years for chronological ages of 6, 7, 8, 9 and 17 years, respectively. Meta-analysis showed no significant differences between BA and CA in African males, Asian females, Caucasians and Hispanics.

Conclusions

The G&P standard is imprecise and should be used with caution when applied to Asian male and African female populations, particularly when aiming to determine chronological age for forensic/legal purposes.

Key Points

• In African females, bone age is significantly advanced when compared to the G&P standard.

• In Asian males, bone age is significantly delayed between 6 and 9 years old inclusive and significantly advanced at 17 years old when compared to the G&P standard.

• The G&P atlas should be used with caution when applied to Asian and African populations, particularly when aiming to determine chronological age for forensic/legal purposes.

Available only for authorised users

Menjívara C, Perreirab KM (2017) Undocumented and unaccompanied: children of migration in the European Union and the United States. J Ethn Migr Stud 34(8):1378–1386 Available from: http://www.tandfonline.com/doi/pdf/10.1080/1369183X.2017.1404255?needAccess=true

Ritz-Timme S, Cattaneo C, Collins MJ et al (2000) Age estimation: the state of the art in relation to the specific demands of forensic practise. Int J Legal Med 113:129–136 Available from: http://www.ncbi.nlm.nih.gov/pubmed/10876982 CrossRefPubMed

Greulich W, Pyle I (1959) Radiographic atlas of skeletal development of the hand and wrist. Stanford University Press, LondonCrossRef

Tanner JM, Healy MJR, Goldstein H, Cameron N (2001) Assessment of skeletal maturity and prediction of adult height (TW3 method). WB Saunders, London

National Institute for Health and Care Excellence. Methods for the development of NICE public health guidance (third edition) | Guidance and guidelines [Internet]. NICE; 2012 [cited 2017 May 18]. Available from: https://www.nice.org.uk/process/pmg4/chapter/appendix-g-quality-appraisal-checklist-quantitativestudies-reporting-correlations-and

R Core Team (2015) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

Demisch A, Wartmann P (1956) Calcification of the mandibular third molar and its relation to skeletal and chronological age in children. Child Dev 27(4):459–473 Available from: http://www.ncbi.nlm.nih.gov/pubmed/13396881 PubMed

Hansman CF, Maresh MM (1961) A longitudinal study of skeletal maturation. Am J Dis Child 101:305–321 Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=13711357 PubMed

Johnston FE (1963) Skeletal age and its prediction in Philadelphia children. Hum Biol 35(2):192–202 Available from: http://www.jstor.org/stable/41448600 PubMed

10.

Andersen E (1971) Comparison of Tanner-Whitehouse and Greulich-Pyle methods in a large scale Danish survey. Am J Phys Anthropol 35(3):373–376 Available from: http://onlinelibrary.wiley.com/doi/10.1002/ajpa.1330350312/full CrossRefPubMed

11.

Roche AF, Davila GH, Eyman SL (1971) A comparison between Greulich-Pyle and Tanner-Whitehouse assessments of skeletal maturity. Radiology 98(2):273–280 Available from: http://pubs.rsna.org/doi/10.1148/98.2.273 CrossRefPubMed

12.

Wenzel A, Droschl H, Melsen B (1984) Skeletal maturity in Austrian children assessed by the GP and the TW-2 methods. Ann Hum Biol 11(2):173–177 Available from: http://www.tandfonline.com/doi/abs/10.1080/03014468400007041 CrossRefPubMed

13.

So LL, Yen PK (1990) Secular trend in skeletalmaturation in southern Chinese girls in Hong Kong. Z Morphol Anthropol 78(2):145–153 Available from: http://www.jstor.org/stable/25757279 PubMed

14.

So LL (1991) Correlation of skeletal maturation with stature and body weight of Southern Chinese girls in Hong Kong. Z Morphol Anthropol 78(3):307–312 Available from: http://www.jstor.org/stable/25757319

15.

Loder RT, Estle DT, Morrison K et al (1993) Applicability of the Greulich and Pyle skeletal age standards to black and white children of today. Am J Dis Child 147(12):1329–1333

16.

Kullman L (1995) Accuracy of two dental and one skeletal age estimation methods in Swedish adolescents. Forensic Sci Int 75(95):225–236CrossRefPubMed

17.

Ontell FK, Ivanovic M, Ablin DS, Barlow TW (1996) Bone age in children of diverse ethnicity. Am J Roentgenol 167(6):1395–1398CrossRef

18.

Jiménez-Castellanos J, Carmona A, Catalina-Herrera C, Viñuales M (1996) Skeletal maturation of wrist and hand ossification centers in normal Spanish boys and girls: a study using the Greulich-Pyle method. Acta Anat (Basel) 155(3):206–211CrossRef

19.

Koc A, Karaoglanoglu M, Erdogan M, Kosecik M, Cesur Y (2001) Assessment of bone ages: is the Greulich-Pylemethod sufficient for Turkish boys? Pediatr Int 43(6):662–665 Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1442-200X.2001.01470.x/full CrossRefPubMed

20.

Mora S, Boechat MI, Pietka E, Huang HK, Gilsanz V (2001) Skeletal age determinations in children of European and African descent: applicability of the Greulich and Pyle standards. Pediatr Res 50(5):624–628 Available from: http://www.nature.com/doifinder/10.1203/00006450-200111000-00015 CrossRefPubMed

21.

van Rijn RR, Lequin MH, Robben SG, Hop WC, Van Kuijk C (2001) Is the Greulich and Pyle atlas still valid for Dutch Caucasian children today? Pediatr Radiol 31(10):748–752 Available from: http://www.springerlink.com/index/2MBWW9YW6J35K8HH.pdf CrossRefPubMed

22.

Krailassiri S, Anuwongnukroh N, Dechkunakorn S (2002) Relationships between dental calcification stages and skeletal maturity indicators in Thai individuals. Angle Orthod 72(2):155–166PubMed

23.

Lewis CP, Lavy CB, Harrison WJ (2002) Delay in skeletal maturity in Malawian children. J Bone Joint Surg Br 84(5):732–734 Available from: http://www.bjj.boneandjoint.org.uk/cgi/doi/10.1302/0301-620X.84B5.12642

24.

Chiang KH, Chou ASB, Yen PS et al (2005) The reliability of using Greulich-Pyle method to determine children’s bone age in Taiwan. Tzu Chi Med J 6:15–18 Available from: http://www.tzuchi.com.tw/tzuchi/tcmj/94-6/1-4.pdf

25.

Garamendi PM, Landa MI, Ballesteros J, Solano MA (2005) Reliability of the methods applied to assess age minority in living subjects around 18 years old: a survey on a Moroccan origin population. Forensic Sci Int 154:3–12CrossRefPubMed

26.

Haiter-Neto F, Kurita LM, Menezes AV, Casanova MS (2006) Skeletal age assessment: a comparison of 3 methods. Am J Orthod Dentofacial Orthop 130(4):435.e15–435.e20CrossRef

27.

Büken B, Safak AA, Yazici B, Büken E, Mayda AS (2007) Is the assessment of bone age by the Greulich-Pyle method reliable at forensic age estimation for Turkish children? Forensic Sci Int 173(2–3):146–153 Available from: http://pubs.rsna.org/doi/abs/10.1148/radiol.2481071451

28.

Griffith JF, Cheng JCY (2007) Are Western skeletal age standards applicable to Hong Kong Chinese? – a comparison of Greulich and Pyle and TW3 methods. Hong Kong Med J 13(3):S28–S32

29.

Schmidt S, Koch B, Schulz R, Reisinger W, Schmeling A (2007) Comparative analysis of the applicability of the skeletal age determination methods of Greulich–Pyle and Thiemann–Nitz for forensic age estimation in living subjects. Int J Legal Med 121(4):293–296 Available from: http://link.springer.com/article/10.1007/s00414-007-0165-7 CrossRefPubMed

30.

Büken B, Erzengin ÖU, Büken E, Şafak AA, Yazici B, Erkol Z (2009) Comparison of the three age estimation methods: which is more reliable for Turkish children? Forensic Sci Int 183(1–3):103.e1–103.e7 Available from: http://www.sciencedirect.com/science/article/pii/S0379073808003939

31.

Zhang A, Sayre JW, Vachon L, Liu BJ, Huang HK (2009) Racial differences in growth patterns of children assessed on the basis of bone age. Radiology 250(1):228–235 Available from: http://pubs.rsna.org/doi/abs/10.1148/radiol.2493080468 CrossRefPubMedPubMedCentral

32.

Calfee RP, Sutter M, Steffen JA, Goldfarb CA (2010) Skeletal and chronological ages in American adolescents: current findings in skeletal maturation. J Child Orthop 4(5):467–470. https://doi.org/10.1007/s11832-010-0289-z CrossRefPubMedPubMedCentral

33.

Zafar AM, Nadeem N, Husen Y, Ahmad MN (2010) An appraisal of greulich-pyle atlas for skeletal age assessment in Pakistan. J Pak Med Assoc 60(7):552–555 Available from: http://www.jpma.org.pk/PdfDownload/2168.pdf PubMed

34.

Santos C, Ferreira M, Alves FC, Cunha E (2011) Comparative study of Greulich and Pyle atlas and Maturos 4.0 program for age estimation in a Portuguese sample. Forensic Sci Int 212(1–3):276.e1–276.e7

35.

Cantekin K, Celikoglu M, Miloglu O, Dane A, Erdem A (2012) Bone age assessment: the applicability of the Greulich-Pylemethod in Eastern Turkish Children. J Forensic Sci 57(3):679–682. https://doi.org/10.1111/j.1556-4029.2011.02035.x/full Available from: http://onlinelibrary.wiley.com CrossRefPubMed

36.

Dembetembe KA, Morris AG (2012) Is Greulich-Pyle age estimation applicable for determining maturation in male Africans? S Afr J Sci 108(9–10) Available from: http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23532012000500015

37.

Moradi M, Sirous M, Morovatti P (2012) The reliability of skeletal age determination in an Iranian sample using Greulich and Pyle method. Forensic Sci Int 223(1–3):372.e1–372.e4

38.

Patil ST, Parchand MP, Meshram MM, Kamdi NY (2012) Applicability of Greulich and Pyle skeletal age standards to Indian children. Forensic Sci Int 216(1–3):200.e1–200.e4

39.

Santoro V, Roca R, De Donno A et al (2012) Applicability of Greulich and Pyle and Demirijan aging methods to a sample of Italian population. Forensic Sci Int 221(1–3):153.e1–153.e5

40.

Soudack M, Ben-Shlush A, Jacobson J, Raviv-Zilka L, Eshed I, Hamiel O (2012) Bone age in the 21st century: is Greulich and Pyle’s atlas accurate for Israeli children? Pediatr Radiol 42:343–348CrossRefPubMed

41.

Suri S, Prasad C, Tompson B, Lou W (2013) Longitudinal comparison of skeletal age determined by the Greulich and Pyle method and chronologic age in normally growing children, and clinical interpretations for orthodontics. Am J Orthod Dentofacial Orthop 143(1):50–60 Available from: http://www.sciencedirect.com/science/article/pii/S0889540612010293CrossRefPubMed

42.

Hackman L, Black S (2013) The reliability of the Greulich and Pyle atlas when applied to a modern Scottish population. J Forensic Sci 58(1):114–119. https://doi.org/10.1111/j.1556-4029.2012.02294.x CrossRefPubMed

43.

Paxton ML, Lamont AC, Stillwell AP (2013) The reliability of the Greulich-Pyle method in bone age determination among Australian children: bone age determination using Greulich-Pyle. J Med Imaging Radiat Oncol 57(1):21–24. https://doi.org/10.1111/j.1754-9485.2012.02462.x/full Available from: http://onlinelibrary.wiley.com CrossRefPubMed

44.

Shilpa PH, Sunil RS, Sapna K, Kumar NC (2013) Estimation and comparison of dental, skeletal and chronologic age in Bangalore south school going children. J Indian Soc Pedod Prev Dent 31(2):63 Available from: http://www.jisppd.com/text.asp?2013/31/2/63/115696

45.

Awais M, Nadeem N, Husen Y, Rehman A, Beg M, Khattak YJ (2014) Comparison between Greulich-Pyle and Girdany-Golden methods for estimating skeletal age of children in Pakistan. J Coll Physicians Surg Pak 24(12):889–893 Available from: https://www.jcpsp.pk/archive/2014/Dec2014/03.pdf

46.

Rai V, Saha S, Yadav G, Tripathi AM, Grover K (2014) Dental and skeletal maturity- a biological indicator of chronologic age. J Clin Diagn Res 8(9):ZC60–ZC64

47.

Mansourvar M, Ismail MA, Raj RG et al (2014) The applicability of Greulich and Pyle atlas to assess skeletal age for four ethnic groups. J Forensic Leg Med 22:26–29CrossRefPubMed

48.

Manzoor Mughal A, Hassan N, Ahmed A (2014) The applicability of the Greulich & Pyle Atlas for bone age assessment in primary schoolgoing children of Karachi, Pakistan. Pak J Med Sci 30(2):409–412

49.

Gungor OE, Celikoglu M, Kale B, Gungor AY, Sari Z (2015) The reliability of the Greulich and Pyle atlas when applied to a southern Turkish population. Eur J Dent 9(2):251–254. https://doi.org/10.1111/j.1556-4029.2012.02294.x/full Available from: http://onlinelibrary.wiley.com CrossRefPubMedPubMedCentral

50.

Kim JR, Lee YS, Yu J (2015) Assessment of bone age in prepubertal healthy Korean children: comparison among the Korean standard bone age chart, Greulich-Pyle method, and Tanner-Whitehouse method. Korean J Radiol 16(1):201–205CrossRefPubMedPubMedCentral

51.

Mohammed RB, Rao DS, Goud AS, Sailaja S, Thetay AA, Gopalakrishnan M (2015) Is Greulich and Pyle standards of skeletal maturation applicable for age estimation in South Indian Andhra children? J Pharm Bioallied Sci 7(3):218–225 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26229357. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4517325

52.

Öztürk F, Karataş OH, Mutaf HI, Babacan H (2016) Bone age assessment: comparison of children fromtwo different regions with the Greulich–Pyle method in Turkey. Aust J Forensic Sci Taylor & Francis 48(6):694–703. https://www.tandfonline.com/doi/full/10.1080/00450618.2015.1119311

53.

Patel PS, Chaudhary AR, Dudhia BB, Bhatia PV, Soni NC, Jani YV (2015) Accuracy of two dental and one skeletal age estimation methods in 6–16 year old Gujarati children. J Forensic Dent Sci 7(1):18 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4330614/

54.

Zabet D, Rérolle C, Pucheux J, Telmon N, Saint-Martin P (2014) Can the Greulich and Pylemethod be used on French contemporary individuals? Int J Legal Med 129(1):171–177. https://doi.org/10.1007/s00414-014-1028-7 Available from: http://link.springer.com CrossRefPubMed

55.

Maggio A, Flavel A, Hart R, Franklin D (2016) Assessment of the accuracy of the Greulich and Pyle hand-wrist atlas for age estimation in a contemporary Australian population. Aust J Forensic Sci Taylor & Francis 618(February):1–11. https://www.tandfonline.com/doi/full/10.1080/00450618.2016.1251970

56.

Feijen L (2008) The Challenges of ensuring protection to unaccompanied and separated children in composite flows in Europe. Refug Surv Q 27(4):63–73. https://doi.org/10.1093/rsq/hdn049 Available from: https://academic.oup.com/rsq/article-lookup/ CrossRef

57.

Himes JH (1984) An early hand-wrist atlas and its implications for secular change in bone age. Ann Hum Biol 11(1):71–75 Available from: http://www.tandfonline.com/doi/abs/10.1080/03014468400006911 CrossRefPubMed

58.

Serinelli S, Panetta V, Pasqualetti P, Marchetti D (2011) Accuracy of three age determination X-ray methods on the left hand-wrist: a systematic review and meta-analysis. Leg Med (Tokyo) 13:120–133CrossRef

59.

Cole TJ (2015) The evidential value of developmental age imaging for assessing age of majority. Ann Hum Biol 42(4):379–388 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26133364 CrossRefPubMedPubMedCentral

60.

Cavalli-Sforza LL, Chisholm B, Menozzi P, Piazza A (1995) The history and geography of human genes. J Asian Stud 54:490 Available from: http://www.jstor.org/stable/2058750?origin=crossref CrossRef

61.

Holderbaum RM, Veeck EB, Oliveira HW, Silva CL, Fernandes A (2005) Comparison among dental, skeletal and chronological development in HIV-positive children: a radiographic study. Braz Oral Res 19(3):209–215

Title: Is the Greulich and Pyle atlas applicable to all ethnicities? A systematic review and meta-analysis
Authors: Khalaf Alshamrani
Fabrizio Messina
Amaka C. Offiah
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 6/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5792-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Is the Greulich and Pyle atlas applicable to all ethnicities? A systematic review and meta-analysis

Abstract

Objective

Methods

Results

Conclusions

Key Points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 6/2019

Alveolar soft-part sarcoma: can MRI help discriminating from other soft-tissue tumors? A study of the French sarcoma group

Introduction of an MR-based semi-quantitative score for assessing partial meniscectomy and relation to knee joint degenerative disease: data from the Osteoarthritis Initiative

Technical challenges of quantitative chest MRI data analysis in a large cohort pediatric study

Texture analysis on conventional MRI images accurately predicts early malignant transformation of low-grade gliomas

Symptom relief and not cyst reduction determines treatment success in aspiration sclerotherapy of hepatic cysts

Diffusion tensor imaging of the sciatic nerve in Charcot–Marie–Tooth disease type I patients: a prospective case–control study