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The Shorthand Bone Age Assessment: A Simpler Alternative to Current Methods

Heyworth, Benton E. MD*; Osei, Daniel A. MD; Fabricant, Peter D. MD, MPH; Schneider, Robert MD; Doyle, Shevaun M. MD; Green, Daniel W. MD; Widmann, Roger F. MD; Lyman, Stephen PhD; Burke, Stephen W. MD; Scher, David M. MD

Journal of Pediatric Orthopaedics: July/August 2013 - Volume 33 - Issue 5 - p 569–574
doi: 10.1097/BPO.0b013e318293e5f2
Selected Topics

Background: Radiographic assessment of skeletal age in pediatric patients is a common practice among orthopaedic surgeons. Current methods of assessment remain labor intensive and require special resources. This study sought to investigate a novel, abridged method of bone age assessment that may serve as a simpler and more efficient alternative to the current standard.

Methods: A shorthand bone age (SBA) method developed at our institution was compared against the Greulich and Pyle method from which it was derived. Standard left hand bone age radiographs of 140 male and 120 female patients, previously assigned skeletal ages ranging from 12.5 to 16 years in males and 10 to 16 years in females by musculoskeletal radiologists using the Greulich and Pyle radiographic atlas, were read using the shorthand method by 3 attending pediatric orthopaedic surgeons and an orthopaedic surgery resident. The shorthand method utilizes a single, univariable criterion for each age, rather than a multivariable subjective comparison to a radiographic atlas. All reviewers were blinded to the original bone age determination. Interobserver reliability, intraobserver reliability, and agreement with the previous records utilizing the atlas were calculated using weighted κ.

Results: The SBA method readings demonstrated substantial agreement with readings by the Greulich and Pyle atlas, demonstrating weighted κ values ranging from 0.71 to 0.75. The SBA method also demonstrated substantial to almost perfect interobserver and intraobserver reliability, with values ranging from 0.77 to 0.87 and from 0.87 to 0.95, respectively.

Conclusions: These results are comparable or superior to previous reports which investigate the validity and reliability of other skeletal age assessment tools. The SBA assessment tool offers a simple and efficient alternative to current methods.

Level of Evidence: Diagnostic study, level III.

*Boston Children's Hospital, Boston, MA

Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO

Hospital for Special Surgery, New York, NY

None of the authors received financial support for this study.

There was no external funding source for the current study.

The authors declare no conflict of interest.

Reprints: David M. Scher, MD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail: ScherD@HSS.EDU.

© 2013 by Lippincott Williams & Wilkins