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Applicability of Greulich and Pyle skeletal age standards to Indian children
Sumit T Patil1, M P Parchand, M M Meshram
1Dept of Anatomy, Government Medical College, GMC Nagpur, Nagpur 440003, Maharashtra, India. dr.sumitpatil1122@gmail.com
Insights
Indian children exhibit significant skeletal age delays compared to the Greulich and Pyle (GP) atlas standards. This study indicates the GP atlas is not universally applicable for assessing bone age in Indian pediatric populations.
Area of Science:
- Pediatric Endocrinology
- Radiology
- Anthropometry
Background:
- Accurate assessment of skeletal maturity is crucial for diagnosing growth disorders and planning treatment.
- The Greulich and Pyle (GP) atlas is a widely used standard for bone age determination.
- Previous studies suggest potential ethnic variations in skeletal development.
Purpose of the Study:
- To evaluate the applicability of the Greulich and Pyle (GP) atlas for determining bone age in Indian children.
- To compare the skeletal age of Indian children with the established American standards.
Main Methods:
- A cross-sectional study involving 375 Indian children (194 males, 181 females) aged 1 day to 19 years.
- Hand and wrist radiographs were obtained for each child.
- Skeletal age was assessed by blinded reviewers using the Greulich and Pyle atlas (2nd ed., 1959).
Main Results:
- Indian boys showed a mean skeletal age delay of 0.7 years, and girls a delay of 0.33 years, across all age groups (1-19 years).
- Skeletal retardation was observed in both sexes compared to the GP atlas, except for girls aged 12-13 years who showed acceleration.
- Significant chronological and skeletal age discrepancies exceeding one year were noted in males between 7 and 12 years.
Conclusions:
- The Greulich and Pyle (GP) atlas demonstrates limited applicability for assessing bone age in Indian children, particularly during middle and late childhood.
- Ethnic-specific standards may be necessary for accurate skeletal age assessment in the Indian pediatric population.
- Findings highlight the need for re-evaluation of current bone age assessment tools for diverse ethnic groups.
Abstract:
A total 375 Indian children of age 1 day to 19 years were studied (male 194 and female 181). For determining the bone age (skeletal age), wrist and hand radiographs were taken. The skeletal age was determined by blinded review of radiograph using Greulich and Pyle atlas (2nd edition, 1959). If we consider all age group (1-19 years), the Indian boys were retarded in skeletal age by 0.7 years and females by 0.33 years. Male and female children skeletally lag behind the American standard (GP Atlas) in all age groups except 12-13 years age group in which girls are accelerated by 0.22 years. Chronological age and skeletal age difference of more than 1 year is seen between age group 7 years and 12 years in males. Females after second year showed a retardation, which ranged from 0.2 to 0.8 years, up to the age of 19 years. The present study concludes that, Greulich and Pyle atlas is not applicable to the Indian children of both sexes especially in middle and late childhood.
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