Comparison between greulich-pyle and girdany-golden methods for estimating skeletal age of children in Pakistan

Objective: To compare Greulich-Pyle (GP) and Girdany-Golden (GG) methods for estimation of Skeletal Age (SA) inchildren referred to a tertiary care hospital in Karachi, Pakistan.Study Design: Cross-sectional study.Place and Duration of Study: Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan, from July2010 to June 2012.Methodology: Children up to the age of 18 years, who had undergone X-ray for the evaluation of trauma were included.Each X-ray was interpreted using both methods by two consultant paediatric radiologists having at least 10 yearsexperience, who were blinded to the actual Chronologic Age (CA) of children.Results: A total of 283 children were included. No significant difference was noted in mean SA estimated by GP methodand mean CA for female children (p=0.695). However, a significant difference was noted between mean CA and mean SAby GG method for females (p=0.011). For males, there was a significant difference between mean CA and mean SAestimated by both GP and GG methods. A stronger correlation was found between CA and SA estimated by GP method(r=0.943 for girls, r=0.915 for boys) as compared to GG method (r=0.909 for girls, r=0.865 for boys) respectively. Bland-Altman analysis also revealed that the two methods cannot be used interchangeably. Excellent correlation was seenbetween the two readers for both GP and GG methods.Conclusion: There was no additional benefit of using GP and GG methods simultaneously over using GP method alone.Moreover, although GP was reliable in estimating SA in girls, it was unable to accurately assess SA in boys. Therefore, itwould be ideal to develop indigenous standards of bone age estimation based on a representative sample of healthynative children.