Abstract
To assess the degree of applicability of bone age calculated by Greulich & Pyle Atlas in estimation of chronological age for therapeutic and medico legal purposes. Two Hundred and Twenty children (139 males, 81 females) between ages of 56 and 113 months (4.5 to 9.5 years) were randomly selected from 4 primary schools of Shireen Jinnah & Clifton, Karachi. Digital images of hand and wrist radiographs were obtained by a computed radiography at Ziauddin Hospital Clifton. Bone ages were computed using Greulich & Pyle Atlas by radiologists at Ziauddin Hospital, North Nazimabad, Karachi. On average, the Greulich & Pyle Atlas underestimates chronological age by 6.65 ± 13.47 months in females and 15.78 ± 12.83 months in males (p-values < 0.001). High correlation was found between chronological age and bone age in both genders (Females r=0.778; p-value< 0.001, Males r=0.816; p-value < 0.001). Bone age calculated by Greulich & Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required (e.g. medicolegal cases). However, serial measurements of bone age by this atlas can be used in management of growth related endocrine disorders in these children.
Highlights
The status of skeletal growth of children is often assessed by calculation of bone age
Bland Altman Plot of females shows a mean difference of +6.65 months between chronological age and bone age. 95% of the points lie between -19.75 months and +33.05 months. 3.7% points lie beyond ± 2 SD lines.(Fig.1)
Bland Altman Plot of males shows a mean difference of +15.78 months between chronological age and bone age. 95% of the points lie between - 9.37 months and +40.93 months. 7.2% points lie beyond ± 2 SD lines.(Fig.2)
Summary
School children between the ages 54 to 113 months (4.5 to 9.5 years) were randomly selected for the study from 4 different schools in the Clifton and Shireen Jinnah Colony Regions of Karachi. Consent forms were signed by parents, subsequently assent forms were signed by children and they were given an appointment at Ziauddin Hospital Clifton. At the hospital their height and weight were noted. Information regarding the date of birth of the included subjects was obtained from school records. Exposure was obtained on an AGFA cassette and digitalized by AGFA 30-X CR Reader.[220] digital images of radiographs were selected and 24 were rejected due to inadequate exposure.
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