Analysis of interrater reliability in age assessment of minors: how does expertise influence the evaluation?

Lorenzo Franceschetti,Lidia Maggioni,Marco Cummaudo,Vera Gloria Merelli,Cristina Cattaneo,Stefania Tritella,Susanna Corona,Francesca Magli,Danilo De Angelis

doi:10.1007/s00414-021-02707-8

Lorenzo Franceschetti, Lidia Maggioni + Show 7 more

Open Access

https://doi.org/10.1007/s00414-021-02707-8

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Abstract

Nowadays, the clinical forensic medical management of migration flows comprises the age assessment of unaccompanied minors. The process of age estimation is a fundamental pillar for legally ensuring the minors’ rights and their protection needs. The procedure is complex and involves different phases and actors, from medical doctors to law enforcement officers. The present study aimed to investigate the performance of Greulich and Pyle, Demirjian, and Mincer methods when performed by raters both trained and without training. Also, the interrater reliability within groups of raters from different areas of expertise was evaluated. A total of 36 participants were enrolled for this study, divided in two groups according to their level of experience with age estimation methods. Each rater was asked to allocate stages and standards for age assessment, evaluating ten orthopantomograms and ten hand-wrist roentgenograms. The interrater reliability expressed through the Fleiss Kappa coefficient and the agreement with the reference standard were calculated. The results showed that none of the categories analyzed could reach a good interrater reliability (ĸ > 0.8) for both methods. The study results highlighted variation and disagreement in the interpretation of the sample among raters and in the subsequent stages and standards allocation. In conclusion, the results of this study highlight that expertise does influence the reliability of the most utilized methods of age estimation of living individuals and stress the importance of proper training and practice, which could greatly increase the accuracy of age assessments.

Highlights

In the global phenomenon of migration, age assessment has gained increasing importance as many countries are obliged to regulate, sort, and “place” the great numbers ofWith regard to unaccompanied foreign minors, age estimation represents a fundamental step to ensure the fulfilment of their protection needs, and it is a complex procedure involving different phases and actors [4,5,6,7,8,9]
Concerning the Greulich and Pyle atlas, the highest interrater reliability was attained by anthropologists (0.72), followed by forensic physicians (0.41), radiologists (0.33), medical students (0.32), non-forensic physicians (0.14), and odontologists (0.07)
The analysis of Fleiss kappa coefficient for raters with sporadic or continuous experience in age estimation resulted in a Fleiss kappa of 0.37 for the dental methods and 0.70 for the handwrist method

Summary

Introduction

In the global phenomenon of migration, age assessment has gained increasing importance as many countries are obliged to regulate, sort, and “place” the great numbers ofWith regard to unaccompanied foreign minors, age estimation represents a fundamental step to ensure the fulfilment of their protection needs, and it is a complex procedure involving different phases and actors [4,5,6,7,8,9]. In 2008, the Study Group on Forensic Age Diagnostic (AGFAD) provided recommendations for age estimation in the living [11], consisting in a three-step procedure which includes a physical examination (anthropometric data, assessment of sexual maturation and identification of potential age-relevant developmental disorders) and an evaluation of the dental status, along with X-ray examinations of the dentition, the left hand, and the clavicle. This latter method is used when the bones of the hand and wrist have completed their development. With a simple three-phase scoring system, the analysis of the medial clavicular epiphysis proved to be the least subjective, while retaining accuracy levels [13]

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