A systematic review and meta-analysis of the self-reported Pubertal Development Scale's applicability to children

Assessing pubertal stage can be challenging, particularly in large-scale settings, due to the sensitive nature of Tanner staging by healthcare providers (HCP) or self-reported Tanner stage through photographs or line drawings. The self-reported Pubertal Development Scale (PDS) avoids sensitive issues like genitalia or nudity, is adaptable to various settings, reduces time and cost burdens on researchers. This study aimed to explore the agreement between self-reported PDS and HCP-assessed Tanner staging.

Papers for the meta review were retrieved from Pubmed, Embase, Fang Wan, CNKI, and Cochrane Library before January 15, 2025. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates and 95 % confidence intervals (CI) were calculated using random-effects models.

Five studies with 6024 participants met inclusion criteria. Among stage 1-5, substantial agreement was found among girls (Wk: 0.63 [0.62-0.65]) and overall participants (Wk: 0.68 [0.67-0.69]), while moderate agreement was observed in boys (Wk: 0.58 [0.56-0.61]). Broadening puberty criteria to stages I-III showed substantial agreement for girls (Wk: 0.66 [0.64-0.68]), boys (Wk: 0.64[0.61-0.67]), and overall participants (Wk: 0.69 [0.67-0.70]). For pubertal onset, using Tanner stage as the gold standard, girls showed that the area under the receiver operating characteristic curve (AUC) was 0.86 (0.85-0.87), the sensitivity and positive predictive value (PPV) of self-reported PDS were 0.85 and 84.2 % respectively. Similarly, among boys, the AUC was 0.89 (95 % CI: 0.87-0.92), the sensitivity and PPV were 0.91 and 97.8 % respectively. Our findings indicate moderate to substantial agreement between the two methods, with high sensitivity and PPV for self-reported PDS in assessing puberty onset, PDS may be a reliable and cost-effective method for large-scale epidemiological studies.