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Reliability of Tanner stage assessments in a multi-center study.

Mark A Espeland1, Dianne Gallagher2, Grethe S Tell1

  • 1Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27103.

American Journal of Human Biology : the Official Journal of the Human Biology Council
|May 19, 2017
PubMed
Summary

Reliability of Tanner stage assessments in adolescent sexual maturation studies is crucial. Inaccurate ratings in the Cooperative Study of Sickle Cell Disease (CSSCD) introduced significant bias, highlighting the need for rigorous clinician training.

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Area of Science:

  • Pediatric Endocrinology
  • Adolescent Health Research
  • Biostatistics in Clinical Trials

Background:

  • Tanner stage indices are standard for assessing adolescent sexual maturation in research.
  • The Cooperative Study of Sickle Cell Disease (CSSCD) utilized Tanner stages to study maturation delays.
  • Clinicians in the CSSCD received insufficient training for accurate Tanner stage assessment.

Purpose of the Study:

  • To evaluate the reliability of Tanner stage assessments within the CSSCD.
  • To quantify the impact of assessment errors on study findings.
  • To demonstrate how improved training can enhance reliability in pubertal assessments.

Main Methods:

  • Analysis of longitudinal Tanner stage data from the CSSCD.
  • Application of a maximum likelihood algorithm to assess inter-rater reliability.
  • Development of models to estimate joint incidence distributions and assessment error rates.

Main Results:

  • Estimated false-positive rates for Tanner stage assessment ranged from 2% to 19%.
  • Estimated false-negative rates ranged from 1% to 18%, consistent across ages.
  • Assessment errors introduced considerable bias and reduced statistical efficiency and power.

Conclusions:

  • Tanner stage assessments in the CSSCD suffered from significant reliability issues.
  • These errors severely impacted the study's statistical efficiency and validity.
  • Emphasizes the critical importance of comprehensive training for accurate pubertal rating in research.