Department of Dental Anthropology and Chair of Forensic Dentistry, University of Zagreb School of Dental Medicine, 10000, Zagreb, Croatia.
University of Split School of Medicine, 21000, Split, Croatia.
Int J Legal Med. 2024 Nov;138(6):2411-2425. doi: 10.1007/s00414-024-03278-0. Epub 2024 Jul 11.
This study explores the reliability of four established legal age threshold estimation approaches in a Croatian sample. We applied Haavikko stages, Demirjian stages, Olze's third molar eruption stages, and second and third molar maturity indices measurement in 593 orthopantomograms of Croatian children and adolescents aged 11.00-20.99 years old. The left mandibular second and third molar were assessed. Logistic regression analysis was conducted to test the significance of predictive variables. Logistic Receiver operating characteristic (ROC) curves were performed to evaluate the classification ability of variables for estimating 14- and 16-year-old thresholds. The areas under the ROC curve (AUC), accuracy (Acc), sensitivity (Se), specificity (Sp), Positive Likelihood Ratio (LR +), Negative Likelihood Ratio (LR-), and Bayes post-test probability (Bayes PTP) were calculated to evaluate classification performance. Results suggest that the combination of I&I is the best classifier for the 14-year-old threshold (AUC = 0.879); for males alone, I is an even better classifier (AUC = 0.881). The highest Acc 80.1% (95%CI, 75.9%-83.9%), Bayes PTP 86.5% (95%CI, 82.8%-89.7%) and Sp 88.9% (95%CI, 83.0%-93.3%) were by I < 0.81 & I < 0.03 in total samples; the highest Acc 86.1% (80.6%- 90.6%), Bayes PTP 87.2% (95%CI, 81.7%- 91.4%) and Sp 87.8% (95%CI, 78.2%- 94.3%) were by I < 0.01 in males, Acc of Haavikko Ac and Demirjian H stage in second molar is very close with slightly lower Bayes PTP and Sp. I is a good classifier for 16-year-old threshold (AUC = 0.889). The cut-off value I < 0.34 can be used to classify the 16-year-old threshold with Acc of 80.6% (95%CI, 77.2%-83.7%), Sp of 83.4% (95%CI, 79.0%-87.3%), and 81.7% (95%CI, 78.4%-84.8%) Bayes PTP. In conclusion, to classify the 14-year-old threshold, a pair of cut-off values I < 0.81 & I < 0.03 can be used in Croatian females; I < 0.01, Demirjian H stage, Haavikko Ac stage in second molar, and the pair I < 0.81 & I < 0.03 can all be used in Croatian males. I < 0.34 can classify the 16-year-old threshold in Croatian populations.
本研究旨在探讨四种已确立的法定年龄阈值评估方法在克罗地亚样本中的可靠性。我们在 593 名年龄在 11.00-20.99 岁的克罗地亚儿童和青少年的口腔全景片中应用了 Haavikko 分期、Demirjian 分期、Olze 的第三磨牙萌出分期以及第二和第三磨牙成熟度指数测量方法。评估了左下颌第二和第三磨牙。进行逻辑回归分析以检验预测变量的显著性。进行逻辑接收者操作特征（ROC）曲线分析，以评估变量对估计 14 岁和 16 岁阈值的分类能力。计算 ROC 曲线下面积（AUC）、准确性（Acc）、敏感性（Se）、特异性（Sp）、阳性似然比（LR+）、阴性似然比（LR-）和贝叶斯后验概率（Bayes PTP），以评估分类性能。结果表明，I&I 的组合是最佳的 14 岁阈值分类器（AUC=0.879）；对于男性单独而言，I 是更好的分类器（AUC=0.881）。最高的准确度为 80.1%（95%CI，75.9%-83.9%）、贝叶斯后验概率为 86.5%（95%CI，82.8%-89.7%）和特异性为 88.9%（95%CI，83.0%-93.3%），是通过总样本中的 I<0.81 & I<0.03 来实现的；最高的准确度为 86.1%（80.6%-90.6%）、贝叶斯后验概率为 87.2%（95%CI，81.7%-91.4%）和特异性为 87.8%（95%CI，78.2%-94.3%），是通过男性中的 I<0.01 来实现的，Haavikko Ac 和 Demirjian H 分期在第二磨牙中的准确性非常接近，贝叶斯后验概率和特异性略低。I 是 16 岁阈值的良好分类器（AUC=0.889）。可以使用 I<0.34 作为分类 16 岁阈值的临界值，具有 80.6%（95%CI，77.2%-83.7%）的准确度、83.4%（95%CI，79.0%-87.3%）的特异性和 81.7%（95%CI，78.4%-84.8%）的贝叶斯后验概率。总之，在克罗地亚女性中，可以使用一对截断值 I<0.81 & I<0.03 来分类 14 岁阈值；在克罗地亚男性中，可以使用 I<0.01、Demirjian H 分期、第二磨牙中的 Haavikko Ac 分期以及 I<0.81 & I<0.03 来分类 14 岁阈值。I<0.34 可用于分类克罗地亚人群的 16 岁阈值。
