PEDIATRICS Vol. 12 No. 2 August 1953, pp. 114-129
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EVALUATION OF THE SKELETAL AGE METHOD OF ESTIMATING CHILDREN'S DEVELOPMENT

I. Systematic Errors in the Assessment of Roentgenograms

DONALD MAINLAND D.SC.1

1 The Department of Anatomy, Dalhousie University, N.S., Canada, and the Department of Medical Statistics, New York University College of Medicine, New York City.

Because of the increasing use of skeletal maturation in the study of children's development and health, thorough exploration of the systematic and variable errors of skeletal age assessment is desirable. The systematic error of one observer (RBM) has been studied by comparing her assessments of hand RGs, reproduced in Macy's Nutrition and Chemical Growth in Childhood, with the published assessments of the same RGs by experts using the same atlases—Todd and co-workers using Todd's atlas and Pyle using the Greulich-Pyle atlas.

RBM's assessments, including duplicate readings on each RG, were all independent of each other, i.e., made without knowledge of chronologic age, of other assessments of the same RG or other RGs from the same child, or of any other information about the child except sex.

RBM tended to estimate the skeletal ages lower than did the experts, and this tendency was greater in the Greulich-Pyle comparison than in the Todd comparison. Her systematic error varied significantly between children and between RGs of the same child. It is suggested that these variations may have arisen from the experts' assessments not being strictly independent.

Even if other observers had as large and as variable a systematic error as RBM, the skeletal assessment method would probably be sufficiently reliable in the comparison of average skeletal ages of groups of children, but it would be of doubtful value in the assessment of a single RG or of a child's progress.

Comparison of the expert assessments with each other showed that the change of the atlas (from Todd to Greulich-Pyle) has altered greatly some of the estimates of skeletal ages in the Macy RGs and even expert assessment has not yet reached a desirable degree of stability.

The requirements in the preparation of a series of test RGs by an expert are outlined. An experiment is described which the reader can conduct on the Mary RGs, and an appeal is issued for the contribution of the data from such experiments to a survey of errors in skeletal assessment.

Submitted on November 12, 1952




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