Rationale and Objective. Large studies have previously been performed to set up a Chinese bone age reference, but it has been difficult to compare the maturation of Chinese children with populations elsewhere due to the potential variability between raters in different parts of the world. We re-analysed the radiographs from a large study of normal Chinese children using an automated bone age rating method to establish a Chinese bone age reference, and to compare the tempo of maturation in the Chinese with other populations. Materials and Methods. X-rays from 2883 boys and 3143 girls aged 2–20 years from five Chinese cities, taken in 2005, were evaluated using the BoneXpert automated method.
Results. Chinese children reached full maturity at the same age as previously studied Asian children from Los Angeles, but 0.6 years earlier than Caucasian children in Los Angeles. The Greulich-Pyle bone age method was adapted to the Chinese population creating a new bone age scale BX-China05. The standard deviation between BX-China05 and chronologic age was 1.01 years in boys aged 8–14, and 1.08 years in girls aged 7–12.
Conclusion. By eliminating rater variability, the automated method provides a reliable and efficient standard for bone age determination in China.
This study included 17 401 normal Han urban children aged 1-20 years from five cities in China in 2005. The skeletal maturity scores were assessed by the Tanner-Whitehouse 3 (TW3) method, and the smoothed centiles curves of scores (TW3-Chinese RUS and TW3-Chinese Carpal) were calculated using the LMS method. The skeletal maturity of the Chinese is approximately the same as Europeans in childhood, but the extent of TW3-RUS skeletal maturity advance in puberty and the ages of complete maturity of TW-Carpals are evidently more advanced in the Chinese.
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