Abstract:

Objective: To evaluate whether the skeletal age assessed by Greulich-Pyle (GP), Chinese human wrist development standard CHN (CHN) and Chinese Wrist Standard - Chinese 05 (TW3-C RUS) will affect clinicians' judgment of skeletal maturity. Methods: Aged 3 to 17 children's left anteroposterior X-ray films were included for short stature, early puberty or suspected growth and development issues, and those of the children who suffering from metabolic genetic, growth disorders, osteochondral disease and had received growth hormone treatment were excluded. Each of the X-ray films was evaluated in three methods by a graduate student who had been trained in skeletal age assessment. Constructing limits of agreement were made by Bland-Altman Method.Results: 567 cases (269 boys, 298 girls) of left anteroposterior radiographs were analyzed. Each gender divided into 7 age groups, the numbers of those groups up to 78 cases, at least 17 cases. 103 boys, 142 girls were in puberty. The skeletal age of CHN method was higher than that of GP method in all age groups, and it was also higher than that of TW3-C RUS method. Except for three age groups, the skeletal age of TW3-C RUS was less than that of GP. The difference between the maximum and the minimum skeletal age of the three methods in all age groups of boys and girls increased with age. In view of the TW3-C RUS upper limit of evaluation , 16-year-old boy, 15-year-old girl, those radiographs assessed by the TW3-C RUS method for boys over or equal 16 years old (18 cases) and girls over or equal 15 years old (34 cases) were excluded. Finally, 515 radiographs (251 boys, 264 girls) entered the consistency limits analysis. In boys, the consistency was good between TW3-C RUS method and GP method, in the 3~4 years' skeletal age group and ~6 years' skeletal age group. In the girls, between CHN method and TW3-C RUS method, in 3~4 years' skeletal age group the consistency was good; Between TW3-C RUS method and GP method, ~8 years' skeletal age group, was with good consistency. There was good consistency between TW3-C RUS and GP in girls without puberty development group, and the consistency of skeletal age and puberty development of the rest group in boys and girls was poor.Conclusion: The skeletal age results obtained by the three skeletal age measurement methods cannot be substituted for each other. The method of evaluating skeletal age should be clear and definite in clinical applications.