RELIABILITY OF SKELETAL AGE ASSESSMENTS

¹ Director of Radiology, Dayton Children’s Medical Center, Dayton, Ohio.
² Pediatric Radiologist, The Johns Hopkins Hospital, Baltimore, Maryland.
³ Head, Department of Radiology and Nuclear Medicine, Children’s Hospital, Buffalo, New York.
⁴ Head, Physica1 Growth and Genetics Section, The Fels Research Institute, Yellow Springs, Ohio.
⁵ Research Associate, The Fels Research Institute, Yellow Springs, Ohio.

An analysis has been made of repeated skeletal age assessments of 50 hand-wrist roentgenograms by 5 observers. These assessments by pediatric radiologists and research workers were made using the tables of Garn and his co-workers⁵ for younger patients and the Greulich and Pyle atlas for older patients.

The replicability of assessments by the pediatric radiologists and the research workers, when using the Greulich and Pyle atlas, was similar to that reported by other experienced assessors and was better at younger than at older ages. The differences between observers were larger for pairs including pediatric radiologists than for the pair of research workers. These differences tended to be smaller when the method of Garn et al.⁵ was used.

The differences between repeated assessments by the research workers were smaller when the Greulich and Pyle atlas was used to make bone-specific assessments than when it was used to make over-all assessments. Data from patients in whom the differences between observers were large indicate that the range of maturity levels within a hand-wrist area influences reliability with the over-all Greulich and Pyle method, but not the bone-specific Greulich and Pyle method. Furthermore, assessments by the over-all method tended to be about 2 months in advance of those made by the bone-specific method. In the younger patients, there were no important mean differences between the levels assigned depending on the method used. When using the Greulich and Pyle atlas, there was a slight tendency for the pediatric radiologists to assign more advanced skeletal ages than the research workers, and this tendency was more marked in older patients.

Each assessor should know his approximate reliability; the way in which this can be determined is discussed.

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