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European Radiology

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Open Access 01-01-2020 | Paediatric

Applicability of two commonly used bone age assessment methods to twenty-first century UK children

Authors: Khalaf Alshamrani, Amaka C. Offiah

Published in: European Radiology | Issue 1/2020

Abstract

Objectives

To assess the effect of secular change on skeletal maturation and thus on the applicability of the Greulich and Pyle (G&P) and Tanner and Whitehouse (TW3) methods.

Methods

BoneXpert was used to assess bone age from 392 hand trauma radiographs (206 males, 257 left). The paired sample t test was performed to assess the difference between mean bone age (BA) and mean chronological age (CA). ANOVA was used to assess the differences between groups based on socioeconomic status (taken from the Index of Multiple Deprivation).

Results

CA ranged from 2 to 15 years for females and 2.5 to 15 years for males. Numbers of children living in low, average and high socioeconomic areas were 216 (55%), 74 (19%) and 102 (26%) respectively. We found no statistically significant difference between BA and CA when using G&P. However, using TW3, CA was underestimated in females beyond the age of 3 years, with significant differences between BA and CA (− 0.43 years, SD 1.05, p = < 0.001) but not in males (0.01 years, SD 0.97, p = 0.76). Of the difference in females, 17.8% was accounted for by socioeconomic status.

Conclusion

No significant difference exists between BoneXpert-derived BA and CA when using the G&P atlas in our study population. There was a statistically significant underestimation of BoneXpert-derived BA compared with CA in females when using TW3, particularly in those from low and average socioeconomic backgrounds. Secular change has not led to significant advancement in skeletal maturation within our study population.

Key Points

• The Greulich and Pyle method can be applied to the present-day United Kingdom (UK) population.

• The Tanner and Whitehouse (TW3) method consistently underestimates the age of twenty-first century UK females by an average of 5 months.

• Secular change has not advanced skeletal maturity of present-day UK children compared with those of the mid-twentieth century.

Available only for authorised users

Martin DD, Wit JM, Hochberg Z et al (2011) The use of bone age in clinical practice - part 1. Horm Res Paediatr 76:1–9. https://doi.org/10.1159/000329372 CrossRefPubMed

Eurostat (2017) Asylum applicants considered to be unaccompanied minors. Luxembourg. Available via https://ec.europa.eu/eurostat/en/web/products-datasets/-/TPS00194Last. Accessed 12 May 2019

Aynsley-Green A, Cole TJ, Crawley H, Lessof N, Boag LR, Wallace RM (2012) Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control. Br Med Bull 102:17–42. https://doi.org/10.1093/bmb/lds014

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 113:129–136CrossRef

Martin DD, Heckmann C, Jenni OG, Ranke MB, Binder G, Thodberg HH (2011) Metacarpal thickness, width, length and medullary diameter in children-reference curves from the First Zürich Longitudinal Study. Osteoporos Int 22:1525–1536. https://doi.org/10.1007/s00198-010-1389-9

Ording Müller L-S, Offiah A, Adamsbaum C et al (2019) Bone age for chronological age determination — statement of the European Society of Paediatric Radiology musculoskeletal task force group. Pediatr Radiol 4–7. https://doi.org/10.1007/s00247-019-04379-4

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

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

Simmons K, Greulich WW (1944) The Brush Foundation study of child growth and development: II. Physical growth and development. Monogr Soc Res Child Dev 9:i. https://doi.org/10.2307/1165542 CrossRef

10.

Satoh M (2015) Bone age: assessment methods and clinical applications. Clin Pediatr Endocrinol 24:143–152. https://doi.org/10.1297/cpe.24.143 CrossRefPubMedPubMedCentral

11.

So LL, Yen PK (1990) Secular trend in skeletal maturation in southern Chinese girls in Hong Kong. Z Morphol Anthropol 78:145–153PubMed

12.

Schmeling A, Schulz R, Danner B, Rösing FW (2006) The impact of economic progress and modernization in medicine on the ossification of hand and wrist. Int J Legal Med 120:121–126. https://doi.org/10.1007/s00414-005-0007-4 CrossRefPubMed

13.

Ulijaszek SJ (2006) The International Growth Standard for Children and Adolescents Project: environmental influences on preadolescent and adolescent growth in weight and height. Food Nutr Bull 27:279–294CrossRef

14.

Büken B, Erzengin OU, Büken E Safak AA, Yazici B, Erkol Z (2009) Comparison of the three age estimation methods: which is more reliable for Turkish children? Forensic Sci Int 183:103.e1–103.e7. https://doi.org/10.1016/j.forsciint.2008.10.012

15.

Thodberg HH, Kreiborg S, Juul A, Pedersen KD (2009) The BoneXpert method for automated determination of skeletal maturity. IEEE Trans Med Imaging 28:52–66. https://doi.org/10.1109/TMI.2008.926067 CrossRefPubMed

16.

Easterlin RA (2000) The worldwide standard of living since 1800. J Econ Perspect 14:7–26CrossRef

17.

Deprtment of Communities and Local Government (2015) English indices of deprivation 2015. 1:1–11

18.

Department of Communities and Local Government (2015) The English Indices of Deprivation 2015 – Frequently Asked Questions (FAQs). 1–19

19.

Maggio A, Flavel A, Hart R, Franklin D (2016) Skeletal age estimation in a contemporary Western Australian population using the Tanner-Whitehouse method. Forensic Sci Int 263:e1–e8. https://doi.org/10.1016/j.forsciint.2016.03.042 CrossRefPubMed

20.

Cameron N (2012) Assessment of maturation. In: Cameron N, Bogin B (Eds) Human growth and development, 2nd edition. Academic Press, Amsterdam, London

21.

Johnson W, Stovitz SD, Choh AC, Czerwinski SA, Towne B, Demerath EW (2012) Patterns of linear growth and skeletal maturation from birth to 18 years of age in overweight young adults. Int J Obes (Lond) 36:535–541. https://doi.org/10.1038/ijo.2011.238

22.

Giuca MR, Pasini M, Tecco S, Marchetti E, Giannotti L, Marzo G (2012) Skeletal maturation in obese patients. Am J Orthod Dentofacial Orthop 142:774–779. https://doi.org/10.1016/j.ajodo.2012.07.011

23.

Satyanarayana K, Naidu AN, Narasinga Rao BS (1980) Adolescent growth spurt among rural Indian boys in relation to their nutritional status in early childhood. Ann Hum Biol 7:359–365. https://doi.org/10.1080/03014468000004431 CrossRefPubMed

24.

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 250:228–235. https://doi.org/10.1148/radiol.2493080468

25.

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 221:153.e1–153.e5. https://doi.org/10.1016/j.forsciint.2012.04.014 CrossRef

26.

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 57:21–24. https://doi.org/10.1111/j.1754-9485.2012.02462.x CrossRefPubMed

27.

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 22:26–29. https://doi.org/10.1016/j.jflm.2013.11.011 CrossRefPubMed

28.

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 0618:1–11. https://doi.org/10.1080/00450618.2016.1251970 CrossRef

29.

Schmidt S, Nitz I, Schulz R, Schmeling A (2008) Applicability of the skeletal age determination method of Tanner and Whitehouse for forensic age diagnostics. Int J Legal Med 122:309–314. https://doi.org/10.1007/s00414-008-0237-3 CrossRefPubMed

30.

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 143:50–60. https://doi.org/10.1016/j.ajodo.2012.08.027 CrossRefPubMed

31.

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

32.

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

33.

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 147:1329–1333. https://doi.org/10.1001/archpedi.1993.02160360071022

34.

Ontell FK, Ivanovic M, Ablin DS, Barlow TW (1996) Bone age in children of diverse ethnicity. AJR Am J Roentgenol 167:1395–1398. https://doi.org/10.2214/ajr.167.6.8956565 CrossRefPubMed

35.

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

36.

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 9:251–254. https://doi.org/10.4103/1305-7456.156846

37.

Pinchi V, De Luca F, Ricciardi F et al (2014) Skeletal age estimation for forensic purposes: a comparison of GP, TW2 and TW3 methods on an Italian sample. Forensic Sci Int 238:83–90. https://doi.org/10.1016/J.FORSCIINT.2014.02.030 CrossRefPubMed

38.

Cole TJ (2000) Secular trends in growth. Proc Nutr Soc 59:317–324. https://doi.org/10.1017/S0029665100000355 CrossRefPubMed

39.

Cole TJ (2003) The secular trend in human physical growth: a biological view. Econ Hum Biol 1:161–168. https://doi.org/10.1016/S1570-677X(02)00033-3 CrossRefPubMed

40.

Alshamrani K, Messina F, Offiah AC (2019) Is the Greulich and Pyle atlas applicable to all ethnicities? A systematic review and meta-analysis. Eur Radiol. https://doi.org/10.1007/s00330-018-5792-5

41.

Cole TJ, Rousham EK, Hawley NL, Cameron N, Norris SA, Pettifor JM (2015) Ethnic and sex differences in skeletal maturation among the Birth to Twenty cohort in South Africa. Arch Dis Child 100:138–143. https://doi.org/10.1136/archdischild-2014-306399

42.

Dahlberg PS, Mosdøl A, Ding Y et al (2019) A systematic review of the agreement between chronological age and skeletal age based on the Greulich and Pyle atlas. Eur Radiol 29:2936–2948

43.

Thodberg HH, van Rijn RR, Jenni OG, Martin DD (2017) Automated determination of bone age from hand X-rays at the end of puberty and its applicability for age estimation. Int J Legal Med 131:771–780. https://doi.org/10.1007/s00414-016-1471-8 CrossRefPubMed

44.

Ng M, Fleming T, Robinson M et al (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:766–781. https://doi.org/10.1016/S0140-6736(14)60460-8 CrossRefPubMedPubMedCentral

45.

Boehmer U, Kressin NR, Berlowitz DR, Christiansen CL, Kazis LE, Jones JA (2002) Self-reported vs administrative race/ethnicity data and study results. Am J Public Health 92:1471–1472

46.

Gomez SL, Kelsey JL, Glaser SL, Lee MM, Sidney S (2005) Inconsistencies between self-reported ethnicity and ethnicity recorded in a health maintenance organization. Ann Epidemiol 15:71–79. https://doi.org/10.1016/J.ANNEPIDEM.2004.03.002

47.

Mersha TB, Abebe T (2015) Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities. Hum Genomics 9:1. https://doi.org/10.1186/s40246-014-0023-x CrossRefPubMedPubMedCentral

48.

Ashizawa K, Kumakura C, Zhou X, Jin F, Cao J (2005) RUS skeletal maturity of children in Beijing. Ann Hum Biol 32:316–325. https://doi.org/10.1080/03014460500087725

49.

Ranabothu S, Kaskel FJ (2015) Validation of automated Greulich–Pyle bone age determination in children with chronic renal failure? Pediatr Nephrol 30:1051–1052. https://doi.org/10.1007/s00467-015-3103-9 CrossRefPubMed

50.

Thodberg HH, Sävendahl L (2010) Validation and reference values of automated bone age determination for four ethnicities. Acad Radiol 17:1425–1432. https://doi.org/10.1016/j.acra.2010.06.007 CrossRefPubMed

51.

Zhang J, Lin F, Ding X (2016) Automatic determination of the Greulich-Pyle bone age as an alternative approach for Chinese children with discordant bone age. Horm Res Paediatr 86:83–89. https://doi.org/10.1159/000446434 CrossRefPubMed

52.

Chaumoitre K, Lamtali S, Baali A et al (2010) Influence of socioeconomic status and body mass index on bone age. Horm Res Paediatr 74:129–135. https://doi.org/10.1159/000313371 CrossRefPubMed

53.

Griffith JF, Cheng JCY, Wong E (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:S28–S32

54.

Chiang K, Chou A, Yen P, Ling C (2005) The reliability of using Greulich-Pyle method to determine children’s bone age in Taiwan. Ci Ji Yi Xue Za Zhi 17:417–420+453

Title: Applicability of two commonly used bone age assessment methods to twenty-first century UK children
Authors: Khalaf Alshamrani
Amaka C. Offiah
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 1/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06300-x

At a glance: The STEP trials

Springer Medicine

Applicability of two commonly used bone age assessment methods to twenty-first century UK children

Abstract

Objectives

Methods

Results

Conclusion

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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