A Simplified Method for Assessing Bone Age in Adolescents

To develop and evaluate a simplified method for skeletal age assessment in adolescents as a rapid alternative to the Greulich-Pyle (GP) method.

Retrospective methodological study comparing the simplified method with the GP atlas, with duplicate readings by experienced and inexperienced raters.

One hundred and seventeen hand and wrist radiographs (67 boys, 50 girls) from adolescents referred for short stature but otherwise healthy. Radiographs with GP-assessed bone age ≥ 9 years in girls and ≥ 11 years in boys were included.

Bone age was scored independently using GP and simplified methods in two rounds by two paediatric endocrinologists and, for the simplified method, two residents. Outcomes included measures of agreement between methods, the proportion of readings within ±1 year of GP, and inter- and intra-rater reliability.

Among experienced raters, the simplified method showed minimal bias relative to GP, with about 91% of readings within ±1 year. Reliability coefficients for both methods exceeded 0.9. Repeatability of the simplified method was slightly lower than GP but remained within clinically acceptable limits and close to predefined acceptability thresholds for inexperienced raters.

The simplified method offers a transparent, standardised, and reproducible approach to adolescent skeletal age assessment. Although not intended to replace the GP method, it is particularly suited to research involving large datasets or resource-limited environments and to population-level skeletal analyses. In busy clinics, it may also serve as a quick check of radiologists' GP-based interpretations, allowing review of reported bone ages without repeating a full atlas assessment.