Abstract
Objectives
This systematic review examines the agreement between assessed skeletal age by the Greulich and Pyle atlas (GP skeletal age) and chronological age.
Methods
We searched electronic databases until January 2017 for studies reporting GP skeletal age and confirmed chronological age in healthy individuals aged 10–25 years. Results are presented as forest plots and meta-analyses (random-effects models).
Results
In separate meta-analyses for each age group and sex (14–18 years for girls, 14–19 years for boys), the pooled mean differences between GP skeletal age and chronological age varied from -0.52 years to 0.47 years. In individual studies, age group and sex-specific mean differences between GP skeletal age and chronological age rarely exceeded 1 year, but between-study heterogeneities were large in most age groups. Few studies examined mean chronological age and distribution for each GP skeletal age. One study of good methodological quality indicates that 95% prediction intervals for chronological age from given GP skeletal ages are typically around 4 years.
Conclusions
There is still good correlation between GP skeletal age and mean chronological age in modern populations. However, the individual variation of development within a population and heterogeneities between studies are substantial.
Key Points
• The GP atlas still corresponds well with mean chronological age in modern populations.
• The substantial variation within a population must be considered.
• The heterogeneity between studies is relatively large and of unknown origin.
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Abbreviations
- CA:
-
Chronological age
- GP:
-
Greulich and Pyle
- RE:
-
Random effects
- SA:
-
Skeletal age
- SD:
-
Standard deviation
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Acknowledgements
We greatly thank Rick R. van Rijn and Abdul Mueed Zafar for providing data, and Marit Johansen for peer review of the literature search strategy.
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The scientific guarantor of this publication is Gunn Elisabeth Vist.
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
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Two of the authors have significant statistical expertise.
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Written informed consent was not required for this study because it is a systematic review.
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Institutional Review Board approval was not required because it is a systematic review.
Study subjects or cohorts overlap
The results have been previously reported in the Norwegian online report “Agreement Between Chronological Age and Bone Age Based on the Greulich and Pyle Atlas for Age Estimation: A Systematic Review [Internet]” (PMID: 29553681)
Methodology
• Systematic review and meta-analysis
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Dahlberg, P.S., Mosdøl, A., Ding, Y. et al. A systematic review of the agreement between chronological age and skeletal age based on the Greulich and Pyle atlas. Eur Radiol 29, 2936–2948 (2019). https://doi.org/10.1007/s00330-018-5718-2
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DOI: https://doi.org/10.1007/s00330-018-5718-2