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

Abstract

ObjectivesTo 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.MethodsBoneXpert 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).ResultsCA 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.ConclusionNo 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. Electronic supplementary materialThe online version of this article (10.1007/s00330-019-06300-x) contains supplementary material, which is available to authorized users.

Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review

“…These results are also consistent with the findings of Nang et al (2023) [78] for Indian children; however, they contrast with those obtained by several authors for the Arab [44,46,47] and African [74] populations in which inter-examiner agreement was stronger in girls than boys. This could be due, among other causes, to differences between the study samples, as we found, contrary to Alshamrani et al (2020b) [55], whose girls had an average age of 8.8 yrs (SD = 3.6), because they included older girls, resulting in greater precision by showing more ossification regions.…”

“…Alshamrani et al (2020) agreed with these results and found that GPA underestimated CA by 4 months (p < 0.01) in Caucasian males [55] from Sheffield (United Kingdom). When analyzed by age, the Scottish study by Hackman and Black (2013) published that in males aged 0-2 yrs, the GPA underestimates the CA from 0.2 to 10 mos (p < 0.05).…”

“…GPA precision showed high concordance among British Caucasian children [55] and southwestern Australians of British ancestry [76]. When the agreement among observers is measured only with Cohen's kappa coefficient it is observed that for Caucasians from Israel [54] and Portugal [60] inter-examiner reliability was weaker than for Anglo-Saxons.…”

“…Analyzed by gender, there are differences in intraclass correlation coefficients when using the GPA. Based on the study of Alshamrani et al (2020b) [55], this coefficient is higher for boys than for girls, which in principle would suggest that the GPA is more accurate in boys than in girls. These results are also consistent with the findings of Nang et al (2023) [78] for Indian children; however, they contrast with those obtained by several authors for the Arab [44,46,47] and African [74] populations in which inter-examiner agreement was stronger in girls than boys.…”

Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review

“…These results are also consistent with the findings of Nang et al (2023) [78] for Indian children; however, they contrast with those obtained by several authors for the Arab [44,46,47] and African [74] populations in which inter-examiner agreement was stronger in girls than boys. This could be due, among other causes, to differences between the study samples, as we found, contrary to Alshamrani et al (2020b) [55], whose girls had an average age of 8.8 yrs (SD = 3.6), because they included older girls, resulting in greater precision by showing more ossification regions.…”

“…Alshamrani et al (2020) agreed with these results and found that GPA underestimated CA by 4 months (p < 0.01) in Caucasian males [55] from Sheffield (United Kingdom). When analyzed by age, the Scottish study by Hackman and Black (2013) published that in males aged 0-2 yrs, the GPA underestimates the CA from 0.2 to 10 mos (p < 0.05).…”

“…GPA precision showed high concordance among British Caucasian children [55] and southwestern Australians of British ancestry [76]. When the agreement among observers is measured only with Cohen's kappa coefficient it is observed that for Caucasians from Israel [54] and Portugal [60] inter-examiner reliability was weaker than for Anglo-Saxons.…”

“…Analyzed by gender, there are differences in intraclass correlation coefficients when using the GPA. Based on the study of Alshamrani et al (2020b) [55], this coefficient is higher for boys than for girls, which in principle would suggest that the GPA is more accurate in boys than in girls. These results are also consistent with the findings of Nang et al (2023) [78] for Indian children; however, they contrast with those obtained by several authors for the Arab [44,46,47] and African [74] populations in which inter-examiner agreement was stronger in girls than boys.…”

Automatic Bone Age Determination in Adult Height Prediction for Girls with Early Variants Puberty and Precoccious Puberty

“…In a study in which 13 male and 103 female patients with a diagnosis of precocious puberty were evaluated, automatic BA measurements made by the clinician and BX were compared and it was found that the mean difference between BX-GP BA and clinician-GP-BA was -0.19 ( 17 ). In another study in which 392 patients were evaluated, it was found that BX-GP BA was not significantly different from clinician-GP BA, but BX-TW BA was significantly lower than clinician-BA ( 18 ). As in previous studies, the present study found the difference between BX-GP BA and Clinician-GP BA to be similar (median 0.005 years, p=0.620)…”

Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review

“…These results are also consistent with the findings of Nang et al (2023) [78] for Indian children; however, they contrast with those obtained by several authors for the Arab [44,46,47] and African [74] populations in which inter-examiner agreement was stronger in girls than boys. This could be due, among other causes, to differences between the study samples, as we found, contrary to Alshamrani et al (2020b) [55], whose girls had an average age of 8.8 yrs (SD = 3.6), because they included older girls, resulting in greater precision by showing more ossification regions.…”

“…Alshamrani et al (2020) agreed with these results and found that GPA underestimated CA by 4 months (p < 0.01) in Caucasian males [55] from Sheffield (United Kingdom). When analyzed by age, the Scottish study by Hackman and Black (2013) published that in males aged 0-2 yrs, the GPA underestimates the CA from 0.2 to 10 mos (p < 0.05).…”

“…GPA precision showed high concordance among British Caucasian children [55] and southwestern Australians of British ancestry [76]. When the agreement among observers is measured only with Cohen's kappa coefficient it is observed that for Caucasians from Israel [54] and Portugal [60] inter-examiner reliability was weaker than for Anglo-Saxons.…”

“…Analyzed by gender, there are differences in intraclass correlation coefficients when using the GPA. Based on the study of Alshamrani et al (2020b) [55], this coefficient is higher for boys than for girls, which in principle would suggest that the GPA is more accurate in boys than in girls. These results are also consistent with the findings of Nang et al (2023) [78] for Indian children; however, they contrast with those obtained by several authors for the Arab [44,46,47] and African [74] populations in which inter-examiner agreement was stronger in girls than boys.…”

Automatic Bone Age Determination in Adult Height Prediction for Girls with Early Variants Puberty and Precoccious Puberty

“…In a study in which 13 male and 103 female patients with a diagnosis of precocious puberty were evaluated, automatic BA measurements made by the clinician and BX were compared and it was found that the mean difference between BX-GP BA and clinician-GP-BA was -0.19 ( 17 ). In another study in which 392 patients were evaluated, it was found that BX-GP BA was not significantly different from clinician-GP BA, but BX-TW BA was significantly lower than clinician-BA ( 18 ). As in previous studies, the present study found the difference between BX-GP BA and Clinician-GP BA to be similar (median 0.005 years, p=0.620)…”

Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review

“…These results are also consistent with the findings of Nang et al (2023) [78] for Indian children; however, they contrast with those obtained by several authors for the Arab [44,46,47] and African [74] populations in which inter-examiner agreement was stronger in girls than boys. This could be due, among other causes, to differences between the study samples, as we found, contrary to Alshamrani et al (2020b) [55], whose girls had an average age of 8.8 yrs (SD = 3.6), because they included older girls, resulting in greater precision by showing more ossification regions.…”

“…Alshamrani et al (2020) agreed with these results and found that GPA underestimated CA by 4 months (p < 0.01) in Caucasian males [55] from Sheffield (United Kingdom). When analyzed by age, the Scottish study by Hackman and Black (2013) published that in males aged 0-2 yrs, the GPA underestimates the CA from 0.2 to 10 mos (p < 0.05).…”

“…GPA precision showed high concordance among British Caucasian children [55] and southwestern Australians of British ancestry [76]. When the agreement among observers is measured only with Cohen's kappa coefficient it is observed that for Caucasians from Israel [54] and Portugal [60] inter-examiner reliability was weaker than for Anglo-Saxons.…”

“…Analyzed by gender, there are differences in intraclass correlation coefficients when using the GPA. Based on the study of Alshamrani et al (2020b) [55], this coefficient is higher for boys than for girls, which in principle would suggest that the GPA is more accurate in boys than in girls. These results are also consistent with the findings of Nang et al (2023) [78] for Indian children; however, they contrast with those obtained by several authors for the Arab [44,46,47] and African [74] populations in which inter-examiner agreement was stronger in girls than boys.…”

Automatic Bone Age Determination in Adult Height Prediction for Girls with Early Variants Puberty and Precoccious Puberty

“…In a study in which 13 male and 103 female patients with a diagnosis of precocious puberty were evaluated, automatic BA measurements made by the clinician and BX were compared and it was found that the mean difference between BX-GP BA and clinician-GP-BA was -0.19 ( 17 ). In another study in which 392 patients were evaluated, it was found that BX-GP BA was not significantly different from clinician-GP BA, but BX-TW BA was significantly lower than clinician-BA ( 18 ). As in previous studies, the present study found the difference between BX-GP BA and Clinician-GP BA to be similar (median 0.005 years, p=0.620)…”