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A systematic review of the agreement between chronological age and skeletal age based on the Greulich and Pyle atlas

  • Forensic Medicine
  • Published:
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Abstract

Objectives

This systematic review examines the agreement between assessed skeletal age by the Greulich and Pyle atlas (GP skeletal age) and chronological age.

Methods

We searched electronic databases until January 2017 for studies reporting GP skeletal age and confirmed chronological age in healthy individuals aged 10–25 years. Results are presented as forest plots and meta-analyses (random-effects models).

Results

In separate meta-analyses for each age group and sex (14–18 years for girls, 14–19 years for boys), the pooled mean differences between GP skeletal age and chronological age varied from -0.52 years to 0.47 years. In individual studies, age group and sex-specific mean differences between GP skeletal age and chronological age rarely exceeded 1 year, but between-study heterogeneities were large in most age groups. Few studies examined mean chronological age and distribution for each GP skeletal age. One study of good methodological quality indicates that 95% prediction intervals for chronological age from given GP skeletal ages are typically around 4 years.

Conclusions

There is still good correlation between GP skeletal age and mean chronological age in modern populations. However, the individual variation of development within a population and heterogeneities between studies are substantial.

Key Points

• The GP atlas still corresponds well with mean chronological age in modern populations.

• The substantial variation within a population must be considered.

• The heterogeneity between studies is relatively large and of unknown origin.

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Abbreviations

CA:

Chronological age

GP:

Greulich and Pyle

RE:

Random effects

SA:

Skeletal age

SD:

Standard deviation

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Acknowledgements

We greatly thank Rick R. van Rijn and Abdul Mueed Zafar for providing data, and Marit Johansen for peer review of the literature search strategy.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424, Oslo, Norway

    Pål Skage Dahlberg, Øyvind Bleka, Veslemøy Rolseth, Marianne Skjerven-Martinsen & Gerd Jorunn Møller Delaveris

  2. Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway

    Annhild Mosdøl, Yunpeng Ding, Gyri Hval Straumann & Gunn Elisabeth Vist

Authors
  1. Pål Skage Dahlberg
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  2. Annhild Mosdøl
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  3. Yunpeng Ding
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  4. Øyvind Bleka
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  5. Veslemøy Rolseth
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  6. Gyri Hval Straumann
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  7. Marianne Skjerven-Martinsen
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  8. Gerd Jorunn Møller Delaveris
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  9. Gunn Elisabeth Vist
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Corresponding author

Correspondence to Pål Skage Dahlberg.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Gunn Elisabeth Vist.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors have significant statistical expertise.

Informed consent

Written informed consent was not required for this study because it is a systematic review.

Ethical approval

Institutional Review Board approval was not required because it is a systematic review.

Study subjects or cohorts overlap

The results have been previously reported in the Norwegian online report “Agreement Between Chronological Age and Bone Age Based on the Greulich and Pyle Atlas for Age Estimation: A Systematic Review [Internet]” (PMID: 29553681)

Methodology

• Systematic review and meta-analysis

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Dahlberg, P.S., Mosdøl, A., Ding, Y. et al. A systematic review of the agreement between chronological age and skeletal age based on the Greulich and Pyle atlas. Eur Radiol 29, 2936–2948 (2019). https://doi.org/10.1007/s00330-018-5718-2

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  • DOI: https://doi.org/10.1007/s00330-018-5718-2

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