Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Türkiye.
Department of Pediatric Health and Diseases, Pediatric Endocrinology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Türkiye.
J Pediatr Endocrinol Metab. 2023 Oct 18;36(12):1181-1185. doi: 10.1515/jpem-2023-0303. Print 2023 Dec 15.
Greulich-Pyle (GP) is one of the most used method for bone age determination (BAD) in various orthopedic, pediatric, radiological, and forensic situations. We aimed to investigate the inter- and intra-observer reliability of the GP method between the most relevant disciplines and its applicability to the Turkish population.
One-hundred and eighty (90 boys, 90 girls) patients with a chronological age younger than 18 (mean 9.33) were included. X-rays mixed by the blinded investigator were evaluated by two orthopedists, two radiologists, and two pediatric endocrinologists to determine skeletal age according to the GP atlas. A month later the process was repeated. As a statistical method, Paired t-test was used for comparison, an Intraclass Correlation Coefficients test was used for reliability and a 95 % confidence interval was determined. Results were classified according to Landis-Koch.
All results were consistent with chronological age (p<0.001), according to the investigators' evaluations compared with chronological age. At the initial evaluation, the interobserver reliability of the method was 0.999 (excellent); at the second evaluation, the interobserver reliability was 0.997 (excellent). The intra-observer reliability of the method was 'excellent' in all observers. When results were separately evaluated by gender, excellent intraobserver correlation and excellent correlation with chronological age were found among all researchers (>0.9). When X-rays were divided into three groups based on age ranges and evaluated, 'moderate' and 'good' correlations with chronological age were obtained during the peripubertal period.
The GP method used in skeletal age determination has excellent inter- and intra-observer reliability. During the peripubertal period, potential discrepancies in bone age assessments should be kept in mind. This method can be used safely and reproducibly by the relevant specialists.
格雷夫利-派尔（GP）是在各种骨科、儿科、放射科和法医情况下进行骨龄测定（BAD）最常用的方法之一。我们旨在研究该方法在最相关学科之间的观察者内和观察者间可靠性及其在土耳其人群中的适用性。
纳入了 180 名（90 名男孩，90 名女孩）年龄小于 18 岁（平均 9.33 岁）的患者。由盲法调查员混合的 X 光片由两名骨科医生、两名放射科医生和两名儿科内分泌医生进行评估，根据 GP 图谱确定骨骼年龄。一个月后重复该过程。作为一种统计方法，采用配对 t 检验进行比较，采用组内相关系数检验进行可靠性检验，并确定 95%置信区间。结果根据 Landis-Koch 进行分类。
根据调查员与实际年龄的评估比较，所有结果均与实际年龄一致（p<0.001）。在初次评估中，该方法的观察者间可靠性为 0.999（优秀）；在第二次评估中，观察者间可靠性为 0.997（优秀）。该方法的观察者内可靠性在所有观察者中均为“优秀”。当按性别分别评估结果时，所有研究人员均发现观察者内相关性优秀，与实际年龄相关性优秀（>0.9）。当根据年龄范围将 X 光片分为三组并进行评估时，在青春期期间，与实际年龄的相关性为“中度”和“良好”。
用于骨骼年龄测定的 GP 方法具有优秀的观察者内和观察者间可靠性。在青春期期间，应注意骨龄评估中的潜在差异。该方法可由相关专家安全且可重复地使用。
