A comparison of 3 different methods for assessment of skeletal age when treating leg-length discrepancies: an inter- and intra-observer study

Authors

  • Anne Berg Breen Division of Orthopedic Surgery, Oslo University Hospital, Oslo
  • Harald Steen Division of Orthopedic Surgery, Oslo University Hospital, Oslo; Biomechanics Lab, Division of Orthopedic Surgery, Oslo University Hospital, Oslo https://orcid.org/0000-0002-3561-5473
  • Are Pripp Oslo Centre of Biostatistics and Epidemiology, University of Oslo
  • Ragnhild Gunderson Division of Radiology, Oslo University Hospital, Oslo
  • Hilde Kristine Sandberg Mentzoni Department of Radiology, Akershus University Hospital, Oslo
  • Else Merckoll Division of Radiology, Oslo University Hospital, Oslo
  • Wajeeha Zaidi Department of Radiology, Akershus University Hospital, Oslo
  • Mikael Lambert Department of Radiology, Akershus University Hospital, Oslo
  • Ivan Hvid Division of Orthopedic Surgery, Oslo University Hospital, Oslo
  • Joachim Horn Division of Orthopedic Surgery, Oslo University Hospital, Oslo; of Clinical Medicine, University of Oslo, Norway https://orcid.org/0000-0002-3380-4457

DOI:

https://doi.org/10.2340/17453674.2021.1133

Keywords:

Bone age, BoneXpert, Greulich and Pyle method, Paediatric orthopaedics, Sauvegrain method

Abstract

Background and purpose — Skeletal maturity is a crucial parameter when calculating remaining growth in children. We compared 3 different methods, 2 manual and 1 automated, in the radiological assessment of bone age with respect to precision and systematic difference.

Material and methods — 66 simultaneous examinations of the left hand and left elbow from children treated for leg-length discrepancies were randomly selected for skeletal age assessment. The radiographs were anonymized and assessed twice with at least 3 weeks’ interval according to the Greulich and Pyle (GP) and Sauvegrain (SG) methods by 5 radiologists with different levels of experience. The hand radiographs were also assessed for GP bone age by use of the automated BoneXpert (BX) method for comparison.

Results — The inter-observer intraclass correlation coefficient (ICC) was 0.96 for the GP and 0.98 for the SG method. The inter- and intra-observer standard error of the measurement (SEm) was 0.41 and 0.32 years for the GP method and 0.27 and 0.21 years for the SG method with a significant difference (p < 0.001) between the methods and between the experienced and the less experienced radiologists for both methods (p = 0.003 and p < 0.001). In 25% of the assessments the discrepancy between the GP and the SG method
was > 1 year. There was no systematic difference comparing either manual method with the automatic BX method.

Interpretation — With respect to the precision of skeletal age determination, we recommend using the SG method or preferably the automated BX method based on GP assessments in the calculation of remaining growth.

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Published

2022-01-11

How to Cite

Breen, A. B., Steen, H., Pripp, A., Gunderson, R., Sandberg Mentzoni, H. K., Merckoll, E., Zaidi, W., Lambert, M., Hvid, I., & Horn, J. (2022). A comparison of 3 different methods for assessment of skeletal age when treating leg-length discrepancies: an inter- and intra-observer study. Acta Orthopaedica, 93, 222–228. https://doi.org/10.2340/17453674.2021.1133

Issue

Section

Non-randomized clinical study