Skeletal age assessment in black African children in Kenya: Applicability of the Greulich and Pyle method

Abstract

Background: One of the most popular methods used for skeletal age assessment is Greulich and Pyle method which was based on a study done in the 1940s on growth and development in Caucasian North American children.

Objective: This study aimed to determine the applicability of Greulich and Pyle standards in assessment of skeletal age in black African children living in Kenya.

Materials and Methods: 110 participants referred for hand and wrist radiographs for evaluation of trauma at Kenyatta National Hospital from January 2017 to December 2017 study period, were included in the study. Chronological age was calculated using the participants’ date of birth. Skeletal age was determined according to the Greulich and Pyle method by three independent investigators who were blinded to the chronological age. Statistical analyses were performed to determine mean differences between chronological age and skeletal age in boys and girls and inter-rater variability.

Results: No statistically significant difference was found between skeletal ages estimated by the 3 observers. (p =0.409) Overall in girls, skeletal age was underestimated compared to chronological age with differences from 2 to 16 months (mean difference =12months) found between estimated skeletal age and chronological age. In boys, skeletal age was underestimated by 4 to 14 months (mean difference =11months) overall compared to chronological age.

Conclusion: The results suggest black African children may have different skeletal development compared to American children from who the Greulich and Pyle atlas was derived and thus it should be used cautiously in age assessment in black African children.