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Applicability of the Greulich and Pyle Skeletal Age Standards to Black and White Children of Today

Randall T. Loder, MD; David T. Estle, MD; Kenneth Morrison, MD; Daniel Eggleston, MD; Daniel N. Fish, MD; Mary Lou Greenfield, MPH, RN; Kenneth E. Guire, MS
Am J Dis Child. 1993;147(12):1329-1333. doi:10.1001/archpedi.1993.02160360071022.
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• Objective.  —The Greulich and Pyle skeletal age atlas was derived from white children of upper socioeconomic level during the 1930s. To our knowledge, the Greulich and Pyle standards have not been reassessed for both black and white children; it was the purpose of this study to reassess 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 between 0 and 18 years. The roentgenograms were scored for bone age by five individuals from different disciplines and levels of training. The difference between the median bone age and the child's chronologic age 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).

Setting.  —The roentgenograms were obtained from four hospital emergency rooms in the Lake Erie basin area, the same geographic area from which the Greulich and Pyle standards originated.

Patients.  —There were 841 children: 452 boys and 389 girls, 461 black and 380 white children.

Results.  —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 delayed during middle childhood by 0.9 year (P<.001) and during late childhood by 0.4 year (P<.01), but they were advanced during the adolescent 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 all children today, especially black girls. We should be aware of this information when making clinical decisions requiring accurate bone ages.(AJDC. 1993;147;1329-1333)

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