APPLICABILITY OF THE GREULICH AND PYLE SKELETAL AGE STANDARDS TO BLACK-AND-WHITE CHILDREN OF TODAY

Objective.-The Greulich and Pyle skeletal age atlas was derived from w hite children of upper socioeconomic level during the 1930s. To our kn owledge, the Greulich and Pyle standards have not been reassessed for both black and white children; it was the purpose of this study to rea ssess the applicability of these standards to today's children. Design .-A ''blinded'' review of hand roentgenograms taken for the evaluation of trauma was performed. Age of the subjects was evenly distributed b etween 0 and 18 years. The roentgenograms were scored for bone age by five individuals from different disciplines and levels of training. Th e difference between the median bone age and the child's chronologic a ge was calculated for each roentgenogram and stratified into four age groups: early childhood (0 to 4 years), middle childhood (4 to 8 years ), late childhood (8 to 13 years), and adolescence (13 to 18 years). S etting.-The roentgenograms were obtained from four hospital emergency rooms in the Lake Erie basin area, the same geographic area from which the Greulich and Pyre standards originated. Patients.-There were 841 children: 452 boys and 389 girls, 461 black and 380 white children. Re sults.-The bone ages and chronologic ages were similar for white girls of all ages. Black girls were skeletally advanced by 0.4 to 0.7 year (P<.001), except during middle childhood. White boys were skeletally d elayed during middle childhood by 0.9 year (P<.001) and during late ch ildhood by 0.4 year (P<.01), but they were advanced during the adolesc ent years by 0.5 year (P<.01). Black boys showed no difference except for the adolescent group, which was skeletally advanced by 0.4 year (P <.02). Conclusions.-The Greulich and Pyle atlas is not applicable to a ll children today, especially black girls. We should be aware of this information when making clinical decisions requiring accurate bone age s.