Concordant Evaluation of Skeletal Age Assessment

Abstract

Objective To evaluate the concordance of artificial rank with single epiphyseal nucleus in skeletal age(SA) assessment between observers and the total concordance. Methods From March 2006 to May 2009, 128 children with central precocious puberty were admitted to the West China Second University Hospital. They were divided into case group (n=61) and control group (n=67). In control group, 6 girls started breast development at age 8. Left hand-wrist X-ray radiographs before therapy were retrospectively blindly analyzed by two doctors with radius, ulna and short bones (RUS) skeletal age of TW2 method. Then the two doctors ranked artificially and calculated skeletal age. Kappa values were calculated and u test was performed in SPSS 13.0. Results ① The Kappa values of the 13 epiphyseal nucleuses were: Radial bone (0.812±0.051), ulnar bone (0.944±0.022), first metacarpal bone(0.925±0.028), metacarpal bone (0.703±0.050), fifth metacarpal bone (0.789±0.042), first proximal phalanx (0.964±0.021), proximal phalanx (0.941±0.026), fifth proximal phalanx(0.887±0.034), middle phalanx (0.917±0.031), fifth middle phalanx (0.919±0.030), first distal phalanx (0.772±0.050), distal phalanx (0.883±0.040), fifth distal phalanx (0.856±0.041). For the 13 Kappa values, u test was performed and P values were all smaller than 0.05. ② Total concordance: Kappa=0.776 and standard error=0.044(u=16.128, P<0.05). Conclusion The concordance of artificial rank with single epiphyseal nucleus in skeletal age assessment between observers is high. In practice work, concordance between observers is developed by regularly training, then diagnostic results are correlated and accuracy is advanced. Key words: age determination by skeleton; TW2 method; concordant evaluation; Kappa value