Bone of contention: The applicability of the Greulich-Pyle method for skeletal age assessment in South Africa.

Matthew Goodier,Dashnee Govender

doi:10.4102/sajr.v22i1.1348

Matthew Goodier, Dashnee Govender

Open Access

https://doi.org/10.4102/sajr.v22i1.1348

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Abstract

BackgroundThe Greulich–Pyle (GP) method is one of the most commonly used radiographic techniques for skeletal age (SA) determination. The applicability of this method for populations outside of the United States has been questioned and this has been investigated in several recent studies around the world. Only limited data are available on the accuracy of the GP method for a South African population.ObjectiveTo determine the accuracy and reliability of the GP method in a population from KwaZulu-Natal, South Africa.MethodA retrospective study was performed using a digital database consisting of 102 hand-wrist radiographs. The SA was estimated by two readers with different levels of experience, using the GP method. Differences between estimated SA and chronological age (CA) were analysed.ResultsSkeletal age determined with the GP method was found to significantly differ from CA. For the population as a whole, the GP method underestimated age. The greatest mean underestimation between SA and CA was 11.5 ± 17 months and 7.4 ± 13.2 months for the 10.1 to 15 year age groups in male and female patients, respectively. The method was found to have excellent inter- and intra-observer reliability.ConclusionThe GP method generally significantly underestimates age for both genders. Overestimation is also possible with individuals as young as 16 years old found by the method to be skeletally mature. Until new SA assessment tools are developed for South Africa, use of supplementary means of determination of SA should be considered, especially in medico-legal cases.

Highlights

Skeletal maturity assessment is used in a variety of settings, including medical, forensic, medicolegal and for sporting reasons.[1,2,3] There are various radiographic methods of skeletal age (SA) assessment; a commonly used technique is to compare a single hand-wrist radiograph with a standard reference.[4]
All the radiographs included in the study were of outpatients who had been imaged in the emergency department for suspected trauma as identified by the history provided on the imaging request form
No method of SA estimation can be completely accurate, the findings of this study support the conclusion that the GP method should be used with caution in the South African population

Summary

Introduction

Skeletal maturity assessment is used in a variety of settings, including medical, forensic, medicolegal and for sporting reasons.[1,2,3] There are various radiographic methods of skeletal age (SA) assessment; a commonly used technique is to compare a single hand-wrist radiograph with a standard reference.[4]. Methods that utilise magnetic resonance imaging or ultrasound have been described but are not widely used.[9,10] Odontological evaluation is a non-radiological technique for estimating SA.[11]. The Greulich–Pyle (GP) method is one of the most commonly used radiographic techniques for skeletal age (SA) determination. The applicability of this method for populations outside of the United States has been questioned and this has been investigated in several recent studies around the world. Limited data are available on the accuracy of the GP method for a South African population

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