Reproducibility and inter-observer agreement of Greulich-Pyle protocol to estimate skeletal age among female adolescent soccer players

Abstract

Background Skeletal age (SA) is considered the best method of assessing biological maturation. The aim of this study was to determine intra-observer (reproducibility) and inter-observer agreement of SA values obtained via the Greulich-Pyle (GP) method. In addition, the variation in calculated SAs by alternative GP protocols was examined. Methods The sample was composed of 100 Portuguese female soccer players aged 12.0–16.7 years. SAs were determined using the GP method by two observers (OB1: experience < 100 exams using GP; OB2: experience > 2000 exams using several methods). The radiographs were examined using alternative GP protocols: (wholeGP) the plate was matched to the atlas as an overall approach; (30-boneGP) bone-by-bone inspections of 30-bones; (GPpmb) bone-by-bone inspections of the pre-mature bones only. For the 30-boneGP and GPpmb approaches, SA was calculated via the mean (M) and the median (Md). Results Reproducibility ranged 82–100% and 88–100% for OB1 and OB2, respectively. Inter-observer agreement (100 participants multiplied by 30 bones) was 92.1%. For specific bones, agreement rates less than 90% were found for scaphoid (81%), medial phalange V (83%), trapezium (84%) and metacarpal V (87%). Differences in wholeGP SAs obtained by the two observers were moderate (d-cohen was 0.79). Mean differences between observers when using bone-by bone SAs were trivial (30-boneGP: d-cohen less than 0.05; GPpmb: d-cohen less than 0.10). The impact of using the mean or the median was negligible, particularly when analyses did not include bones scored as mature. Conclusion The GP appeared to be a reasonably reproducible method to assess SA and inter-observer agreement was acceptable. There is evidence to support a recommendation of only scoring pre-mature bones during later adolescence. Further research is required to examine whether these findings are consistent in younger girls and in boys.

CORR Insights®: Does the Use of Sanders Staging and Distal Radius and Ulna Classification Avoid Mismatches in Growth Assessment with Risser Staging Alone?

“…To get there, we need large samples of serial imaging and assessments of children, either through clinical tracking or prospective population-based studies. A few longstanding prospective cohorts exist, including the Bolton-Brush Study and the Fels Longitudinal Study, upon which several efforts focusing on the hand-wrist have been conducted [4,10,14]. Unfortunately, the most accessible materials are cross-sectional studies, which are not particularly useful given the wide variation of maturational trajectories possible.…”

“…Atlas-based systems such as the Greulich-Pyle method [5], when done properly, can be even more time consuming, assigning an individual age to each bone of the hand and combining them into a global skeletal age. To reduce assessment time, this method is often reduced to evaluating either just a few bones or determining a “whole hand” age assignment based on the single best-matching plate, which results in estimates from Gruelich-Pyle having large interobserver error [4].…”

Effect of AI-assisted software on inter- and intra-observer variability for the X-ray bone age assessment of preschool children

“…For the 2nd interpretation, the ICCs for the 6 residents (residents 1–6) were also compared in the same way. An ICC value greater than 0.75 is excellent, from 0.75 to 0.60 is good, from 0.59 to 0.40 is fair and below 0.40 is poor agreement[ 15 , 18 , 21 ].…”

Estimating the 18-Year Threshold with Third Molars Radiographs in the Southern Italy Population: Accuracy and Reproducibility of Demirjian Method

“…The physical examination, evaluating some somatic traits (weight, height, overall body development) and the degree of sexual maturation can provide relevant information, especially in pre-pubertal age, and therefore not applicable in the determination of the major age [ 4 ]. However, the most reliable methods involve bone age, which indicates a person’s skeletal maturity and can be useful in estimating chronological age more accurately [ 5 ]. Different methods to calculate age according to X-ray findings have been widely adopted, i.e., wrist-hand X-ray, hip X-ray, cervical spine X-ray, CT of the clavicle, and orthopantomography [ 2 ].…”

“…Until the end of adolescence, when bone elongation has ended, the bones of the hand and wrist can be good indicators of an individual’s age. X-rays of the hand and wrist allow age estimation by comparison with standard values of maturation and bone age [ 5 ]. Wrist-hand X-ray offers the best compromise between diagnostic accuracy and radiation exposure according to the ALARA principle, a safety recommendation designed to minimize radiation doses “as low as reasonably achievable”.…”