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The reliability of the Greulich-Pyle method in bone age determination among Australian children
Mark L Paxton1, Anthony C Lamont, Andrew P Stillwell
1Department of Medical Imaging, The Townsville Hospital, Townsville, Queensland, Australia. markpaxtonhome@gmail.com
Insights
The Greulich-Pyle (G&P) method accurately determines bone age (BA) in Australian children. This study found G&P standards reliable for assessing skeletal maturity in this population.
Area of Science:
- Pediatric Endocrinology
- Radiology
- Growth Assessment
Background:
- Bone age (BA) determination is crucial for assessing growth in children.
- The Greulich-Pyle (G&P) method, developed in the 1930s, is widely used but its applicability across diverse populations is questioned.
- This study addresses the need to validate G&P's accuracy in a contemporary Australian pediatric cohort.
Purpose of the Study:
- To evaluate the accuracy of the Greulich-Pyle (G&P) method for bone age (BA) determination in Australian children.
- To assess potential variations in G&P accuracy based on age, gender, and hand laterality.
Main Methods:
- Retrospective analysis of hand X-rays from 406 Australian children (under 18) investigated for trauma.
- Comparison of bone age (BA) determined by the G&P method against chronological age (CA).
- Statistical analysis to identify differences in BA-CA means across demographic subgroups and assess inter-observer reliability.
Main Results:
- Overall, BA was found to be 2.2 months less than CA (P=0.005).
- Females showed a greater mean difference (BA 3.7 months less than CA, P=0.002) compared to males (BA 1.5 months less than CA, P=0.142).
- High intra-observer (P=0.846) and inter-observer (P=0.102) reliability was confirmed.
Conclusions:
- The Greulich-Pyle (G&P) method demonstrates accuracy for bone age (BA) determination in the studied Australian pediatric population.
- Despite minor systematic differences, the G&P standards are considered reliable for clinical use in this cohort.
- The findings support the continued use of G&P for growth assessment in Australian children.
Introduction:
Bone age (BA) determination in skeletally immature children has been used as a measurement of growth for many years. The Greulich-Pyle (G&P) method of estimating BA is most commonly used. The standards used within this atlas were compiled from research conducted on normal white children in the United States, during the 1930s. The applicability of G&P beyond populations similar to its own can be variable. The aim of this study was to determine the accuracy of G&P in BA determination among Australian children.
Methods And Materials:
Hand X-rays of children under the age of 18, investigated for trauma, were recruited. Mean differences between BA, according to the standards of G&P, and chronological age (CA) were compared among all patients and subgroups according to age, gender and left versus right hand.
Results:
Between January and December 2010, 654 children underwent hand X-rays, 406 of these were included (276 males and 130 females). Overall BA was 2.2 months less than CA (P-value = 0.005). BA of males and females was estimated to be 1.5 months (P-value = 0.142) and 3.7 months (P-value = 0.002) less than their CA respectively. No statistically significant difference was identified with intra-observer (P-value = 0.846) and inter-observer interpretations (P-value = 0.102).
Conclusions:
Our results show that the standards of G&P are an accurate means of BA determination in Australian children.
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