Article2010

An appraisal of Greulich-Pyle Atlas for skeletal age assessment in Pakistan.

Abdul Mueed Zafar · Naila Nadeem · Yousuf A. Husen · Muhammad Nadeem Ahmad

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Forensic Anthropology and Bioarchaeology Studies Child Abuse and Related Trauma Reliability and Agreement in Measurement

Abstract

OBJECTIVE: To assess accurate skeletal age (SA) in clinical and medico-legal decisions using the Greulich-Pyle (GP) atlas and to see its applicability across diverse populations in Karachi. METHODS: Hand-Wrist radiographs obtained at our institution from January 2005 to March 2008, for an indication of trauma, in subjects with chronological age (CA) up to 216 months, were reviewed by two radiologists blinded to CA. Subjects ever investigated for metabolic, growth or nutritional disorders were excluded. SA was assessed according to GP atlas. To establish inter-observer reliability, 100 random radiographs were dually evaluated. Both sexes were divided into four subgroups. For each subgroup, difference between skeletal and chronological age was calculated. (paired t-test, alpha < 0.05). RESULTS: Total 889 radiographs were analyzed. Inter-observer correlation coefficient was 0.992 (p < 0.001). Mean differences of up to 13 months between SA and CA were documented. The differences were statistically significant in all groups except adolescent males. CONCLUSION: Our findings suggest against the applicability of GP atlas for accurate SA assessment in Pakistani children.

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References

1959RADIOGRAPHIC ATLAS OF SKELETAL DEVELOPMENT OF THE HAND AND WRIST 1996Bone age in children of diverse ethnicity.2001Skeletal Age Determinations in Children of European and African Descent: Applicability of the Greulich and Pyle Standards 1994Reproducibility of bone ages when performed by radiology registrars: an audit of Tanner and Whitehouse II versus Greulich and Pyle methods 2007Is the assessment of bone age by the Greulich–Pyle method reliable at forensic age estimation for Turkish children?1999The reliability of bone age determination in central European children using the Greulich and Pyle method.2001Is the Greulich and Pyle atlas still valid for Dutch Caucasian children today?2001Assessment of bone ages: Is the Greulich‐Pyle method sufficient for Turkish boys?

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