COMPUTER-AIDED SKELETAL AGE SCORES IN HEALTHY-CHILDREN, GIRLS WITH TURNER SYNDROME, AND IN CHILDREN WITH CONSTITUTIONALLY TALL STATURE

The manual Tanner-Whitehouse 2 method has recently been transformed in to a computer-aided skeletal age scoring system (CASAS), which rates e ither the complete TW-RUS score (13b model) or a subset consisting of radius, ulna, and the four bones of the third finger (6b model). In th is study the reliability of CASAS was evaluated in healthy children, a nd the 13b model was compared with the manual ratings and with the 6b model in (subgroups of) 151 healthy children, 87 girls with Turner syn drome, and 362 children with constitutionally tall stature. In additio n, reference curves for bone maturation in Turner syndrome and constit utionally tall stature are presented. Some of mean differences in meth ods were statistically significant; however, because these mean differ ences were less than 0.4 bone age ''year,'' they are clinically not si gnificant. In all comparisons the range of the difference between the methods (either with the 6b or the 13b model) was considerable, but th e combined within-and between-components of variance (0.7%) were in th e same order of magnitude as reported for the manual readings. In gene ral, the percentage of equal stage ratings on duplicate assessments wa s high (+/-90%). Our data indicate that this comput computerized metho d is applicable in these groups of children. The use of the 6b model s eems preferable because it is less time-consuming than the rating of 1 3 bones. In view of the percentages of manual insertions of a stage (u p to 8% in all groups) the clinical use of this CASAS version (3.5) se ems to be more efficient, particularly with longitudinal studies. Manu al substitution of a stage should be avoided, and when performed its p ercentage and the limits for the acceptance of disagreement should be reported.