Simplified Skeletal Maturity Scoring System

Verma, Kushagra; Sitoula, Prakash; Gabos, Peter G.; Loveland, Kerry; Verma, Satyendra; Shah, Suken A.

doi:10.1097/brs.0000000000000653

Cited by 17 publications

(10 citation statements)

References 15 publications

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“…This period is best represented by TW3 stage G (dominant capping appearance in the majority of the epiphyses of all 5 digits 2 , 3 ), corresponding to SSMS stage 3 2 and TOCI stage 5. Advanced capping (TW3 stage G) of the thumb proximal phalanx also matched with advanced capping (TW3 stage G) in all 4 ulnar digits, with a concordance rate of 82.0% (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Sanders et al proposed the digital skeletal age (DSA) score 1 and then the simplified skeletal maturity system (SSMS) 2 , derived from the original Tanner-Whitehouse III radius, ulna and short bone (RUS)—or TW3—method, and these systems were recognized widely as the gold standards for clinical management of idiopathic scoliosis. In a recent multicenter validation study, the SSMS was found to be associated with a steep learning curve for less experienced users 3 and thus might have limitations for rapid clinical usage.…”

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confidence: 99%

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Validation Study of the Thumb Ossification Composite Index (TOCI) in Idiopathic Scoliosis

Hung

Shi

Chow

et al. 2018

The Journal of Bone and Joint Surgery

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Background:The new simplified thumb ossification composite index (TOCI) based on ossification of the thumb epiphyses and adductor sesamoid has demonstrated simplicity, excellent reliability, and high accuracy for predicting skeletal maturity, comparable with the Sanders simplified skeletal maturity system (SSMS). It was our belief that, because the terminology of the SSMS system has been commonly used for skeletal maturity prediction in idiopathic scoliosis in publications over the past decade, the clinical applicability of the TOCI system would increase if the stages in the 2 systems were found to be interchangeable and highly correlated.Methods:Hand radiographs of 125 premenarchal girls with newly diagnosed adolescent idiopathic scoliosis who had been followed longitudinally until skeletal maturity were all scored with use of the Tanner-Whitehouse III (TW3) system (stages E through I), the TOCI, and the SSMS. The scores for the epiphyses of the ulnar 4 digits were compared with those for the thumb and correlated with the timing of peak height velocity. Correlations were analyzed with the chi-square test and Cramer V and Somers delta correlations.Results:Six hundred and forty-five hand radiographs (an average of 5 for each girl with idiopathic scoliosis) and 11,517 epiphyses were scored. The rate of concordance between TW3 stages F, G, and I for the thumb proximal phalangeal epiphysis and those for all of the epiphyses of the ulnar 4 digits were 72.5%, 72.5%, and 89.9%, respectively. The overall concordance rate (including all epiphyses) was 71.3%, with a very high Cramer V correlation and significance (p < 0.01). High interchangeability was demonstrated for the TOCI and SSMS stages, supported by a high Somers delta correlation (>0.8) with significance (p < 0.05).Conclusions:The TOCI is highly practical for clinical use, and its stages are highly interchangeable with those of the SSMS.Clinical Relevance:The TOCI could serve as a simplified “marker” of skeletal maturity on hand radiographs and minimize the learning-curve problems associated with the SSMS in a busy clinical practice.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Validation Study of the Thumb Ossification Composite Index (TOCI) in Idiopathic Scoliosis

Hung

Shi

Chow

et al. 2018

The Journal of Bone and Joint Surgery

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“…They reported that the SSMS had excellent correlation with the curve acceleration phase (r = 0.9) in 22 female subjects and excellent reliability among senior orthopaedic surgeons 4 . However, a subsequent validation study of 275 patients demonstrated a steep learning curve for less experienced users 16 . Other recently reported simplified models using the olecranon apophysis 17 or the distal part of the radius and the ulnar epiphysis 3 (DRU classification) were either not evaluated in strictly conducted longitudinal studies or not fully validated through comparison with the standard DSA and RUS scoring systems.…”

Section: Discussionmentioning

confidence: 99%

“…6 ). Radiographically, both the TOCI and the SSMS still rely on distal radial epiphyseal fusion status to determine the end of growth, although it is controversial whether clinically relevant growth is still possible at the late radiographic stages of fusion of the distal radial physis 16 . The SSMS may provide more clarity about growth remaining at this stage since it shows the distal radial physis.…”

Section: Discussionmentioning

confidence: 99%

Thumb Ossification Composite Index (TOCI) for Predicting Peripubertal Skeletal Maturity and Peak Height Velocity in Idiopathic Scoliosis

Hung

Chau²,

Shi³

et al. 2017

The Journal of Bone and Joint Surgery

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Background:Accurate skeletal maturity assessment is important to guide clinical evaluation of idiopathic scoliosis, but commonly used methods are inadequate or too complex for rapid clinical use. The objective of the study was to propose a new simplified staging method, called the thumb ossification composite index (TOCI), based on the ossification pattern of the 2 thumb epiphyses and the adductor sesamoid bone; to determine its accuracy in predicting skeletal maturation when compared with the Sanders simplified skeletal maturity system (SSMS); and to validate its interrater and intrarater reliability.Methods:Hand radiographs of 125 girls, acquired when they were newly diagnosed with idiopathic scoliosis prior to menarche and during longitudinal follow-up until skeletal maturity (a minimum of 4 years), were scored with the TOCI and SSMS. These scores were compared with digital skeletal age (DSA) and radius, ulna, and small hand bones (RUS) scores; anthropometric data; peak height velocity; and growth-remaining profiles. Correlations were analyzed with the chi-square test, Spearman and Cramer V correlation methods, and receiver operating characteristic curve analysis. Reliability analysis using the intraclass correlation (ICC) was conducted.Results:Six hundred and forty-five hand radiographs (average, 5 of each girl) were scored. The TOCI staging system was highly correlated with the DSA and RUS scores (r = 0.93 and 0.92, p < 0.01). The mean peak height velocity (and standard deviation) was 7.43 ± 1.45 cm/yr and occurred at a mean age of 11.9 ± 0.86 years, with 70.1% and 51.4% of the subjects attaining their peak height velocity at TOCI stage 5 and SSMS stage 3, respectively. The 2 systems predicted peak height velocity with comparable accuracy, with a strong Cramer V association (0.526 and 0.466, respectively; p < 0.01) and similar sensitivity and specificity on receiver operating characteristic curve analysis. The mean age at menarche was 12.57 ± 1.12 years, with menarche occurring over several stages in both the TOCI and the SSMS. The growth remaining predicted by TOCI stage 8 matched well with that predicted by SSMS stage 7, with a mean of <2 cm/yr of growth potential over a mean of <1.7 years at these stages. The TOCI also demonstrated excellent reliability, with an overall ICC of >0.97.Conclusions:The new proposed TOCI could provide a simplified staging system for the assessment of skeletal maturity of subjects with idiopathic scoliosis. The index needs to be subjected to further multicenter validation in different ethnic groups.

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“…Additional studies are needed to validate this DRU classification in other ethnicities and populations and to further directly compare it with other new and established skeletal maturity schemes. 24 25 26 27 …”

Section: Discussionmentioning

confidence: 99%

Reliability Analysis of the Distal Radius and Ulna Classification for Assessing Skeletal Maturity for Patients with Adolescent Idiopathic Scoliosis

Cheung

Samartzis

Luk

2015

Global Spine Journal

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Study Design Prospective radiographic study. Objective To test the reliability of the Distal Radius and Ulna Classification (DRU). Methods This single-center study included prospectively recruited subjects with adolescent idiopathic scoliosis managed with bracing. The left-hand radiographs were measured using the DRU classification by two examiners. Intra- and interobserver reliability analysis were performed using intraclass correlation (ICC) analysis. Results From these clinics, 161 patients (124 females and 37 males) with left-hand radiographs were included in the study. The mean age was 13.3 years (standard deviation: 1.5). There was excellent intra- (ICC: 0.93 to 0.95) and interobserver (ICC: 0.97) reliability. Conclusions The DRU classification scheme has been shown to be accurate in determining the peak growth phase and growth cessation. It has now been confirmed to be a reliable tool. Future prospective studies should be performed to investigate its application in deciding when to apply bracing or operative treatment.

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Simplified Skeletal Maturity Scoring System

Abstract: 2.

Cited by 17 publications

References 15 publications

Validation Study of the Thumb Ossification Composite Index (TOCI) in Idiopathic Scoliosis

Validation Study of the Thumb Ossification Composite Index (TOCI) in Idiopathic Scoliosis

Thumb Ossification Composite Index (TOCI) for Predicting Peripubertal Skeletal Maturity and Peak Height Velocity in Idiopathic Scoliosis

Reliability Analysis of the Distal Radius and Ulna Classification for Assessing Skeletal Maturity for Patients with Adolescent Idiopathic Scoliosis

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