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Effect of Knowledge of Actual Age on Bone Age Determination

Harvard Medical School Children's Hospital Boston, MA 02115

Unless I misunderstand, there are errors in arithmetic in Table 4 of the article by Berst et al. [1] on the effect of knowledge of the actual age of children whose bone age is being determined. I think the line for "all observers" should read 268/428 (63%) and 207/428 (48%). If this is so, when the true age was known, the observers unconsciously shifted even more children into the normal range than the article states. The normal readings rose from 48% of all determinations to 63%. The 15% increase in reported normality was presumably an artifact caused by foreknowledge of the patient's chronologic age. Had this not been a research situation, the children so shifted would not have received optimal radiologic care.

This observation makes even more emphatic the authors' very valuable message, "Observers are more likely to interpret the radiograph as showing normal findings when the chronologic age is known" [1]. To me, the deduction is obvious: Objectivity is reduced when the radiologist learns the actual age before he or she has estimated the bone age; accuracy is enhanced when the bone age is determined first. The authors have provided an excellent example of radiologists allowing themselves to be biased by fore-knowledge of patient history.

References

1. Berst MJ, Dolan L, Bogdanowicz MM, Stevens MA, Chow S, Brandser EA. Effect of knowledge of chronologic age on the variability of pediatric bone age determined using the Greulich and Pyle standards. AJR 2001;176:507 -510[Abstract/Free Full Text]

Reply

University of Iowa Hospitals and Clinics Iowa City, IA 52242

My colleagues and I certainly appreciate Dr. Griscom's efforts, thoroughness, and comments on our article [1]. After reviewing our data and calculations, we agree that a mathematical error is present in Table 4. The sum of the two columns represented by "all observers" should read 268/428 (63%) and 207/428 (48%) instead of 248/428 (58%) and 205/428 (48%), respectively. We apologize for this error and agree that this 15% increase in reported normality only strengthens our conclusion that observers are more likely to interpret a radiograph as normal when the chronologic age is known than when it is not known.

References

1. Berst MJ, Dolan L, Bogdanowicz MM, Stevens MA, Chow S, Brandser EA. Effect of knowledge of chronologic age on the variability of pediatric bone age determined using the Greulich and Pyle standards. AJR 2001;176:507 -510

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				N. T. Griscom A Suggestion: Look at the Images First, Before You Read the History Radiology, April 1, 2002; 223(1): 9 - 10. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Griscom, N. T. Articles by Berst, M. Search for Related Content PubMed PubMed Citation Articles by Griscom, N. T. Articles by Berst, M. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?