Skeletal Age Assessment in Black African Children in Kenya: Applicability of the Greulich and Pyle Method

Abstract

STUDY BACKGROUND Skeletal age assessment is vital in diagnosis and follow up of pediatric growth and development disorders, as well as useful in medico-legal cases where age is unknown or unavailable. The most popular method used worldwide for skeletal age assessment is the Greulich and Pyle method which was based on a study done in the 1940s on growth and development in Caucasian North American children. BROAD OBJECTIVE To determine the applicability of GP standards in assessment of skeletal age in black African children living in Kenya. STUDY DESIGN AND SITE A cross sectional study was carried out at Kenyatta National Hospital (KNH). The GE Digital radiography Revolution XRd machine installed at the radiology department in Kenyatta National Hospital, was used for the study. PARTICIPANTS The study included children and adolescents referred for hand and wrist radiographs at Kenyatta National Hospital. SAMPLING METHOD AND SIZE The study included a total of 110 participants. The convenience sampling method was used to select the participants. MATERIALS AND METHODS Hand and wrist radiographs of children and adolescents referred for evaluation of trauma were used. 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. ix | P a g e A data collection sheet was used to record the patients’ demographic data, chronological age and skeletal age determined by each investigator. A p value was derived from the correlation coefficient analysis was reported and significant correlation between the variables representing chronological and estimated age was determined by a cut off value of 0.05. EXPECTED MAIN OUTCOME AND MEASURES The mean differences between the chronological age and skeletal age from each investigator were analyzed. Inter-observer variability was also analyzed. The data was analyzed using the statistical package for social scientists (SPSS) computer software package and the results presented in the form of tables, charts and graphs. The data will be made available to UON and KNH.