title: Is the Greulich and Pyle atlas still valid for Dutch Caucasian children today?
abstract: BACKGROUND
  In our Paediatric Radiology Department, the Greulich and Pyle technique is used to assess skeletal age. Several authors have raised questions with regard to the applicability of this technique in a contemporary paediatric and adolescent population.
  
  
  OBJECTIVE
  To compare skeletal age and calendar age in a healthy Dutch Caucasian population in order to test the applicability in this specific population.
  
  
  METHODS
  For this study we enrolled 278 Dutch Caucasian boys (age range 5.0-19.5 years, mean 12.6 years) and 294 Dutch Caucasian girls (age range 5.2-19.9 years, mean 12.2 years). Radiographs of the left hand were scored according to the Greulich and Pyle atlas by two investigators.
  
  
  RESULTS
  Intra-observer coefficient of variation of duplicate assessment of skeletal age for investigator 1 (resident) was 2.4 % and for investigator 2 (radiologist) was 1.5 %. We found no significant systematic differences between the two observers regarding variability and levels of measurement, and the agreement was good. There was a strongly significant correlation between skeletal and calendar age rgirls = 0.974 and rboys = 0.979 (P < 0.001). On average, calendar age preceded skeletal age by a small amount (1.7 months in girls and 3.3 months in boys, both P < 0.001).
  
  
  CONCLUSIONS
  The reliability of the Greulich and Pyle atlas in our study corresponds well with previously reported studies. Based on our data, we conclude that the Greulich and Pyle atlas is still applicable in Dutch Caucasian children and adolescents.
authors.affiliation: Department of Radiology, Suite D 206, University Hospital Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. vanrijn@rond.azr.nl
authors.forename: R R
authors.initials: RR
authors.lastname: van Rijn
authors.forename: M H
authors.initials: MH
authors.lastname: Lequin
authors.forename: S G
authors.initials: SG
authors.lastname: Robben
authors.forename: W C
authors.initials: WC
authors.lastname: Hop
authors.forename: C
authors.initials: C
authors.lastname: van Kuijk
mesh_terms: D000293:Adolescent; D000328:Adult; D000365:Age Determination by Skeleton / Q000379:methods*; D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D009426:Netherlands; D012016:Reference Values; D013997:Time Factors; D044465:White People