title: An appraisal of Greulich-Pyle Atlas for skeletal age assessment in Pakistan.
abstract: OBJECTIVE
  To assess accurate skeletal age (SA) in clinical and medico-legal decisions using the Greulich-Pyle (GP) atlas and to see its applicability across diverse populations in Karachi.
  
  
  METHODS
  Hand-Wrist radiographs obtained at our institution from January 2005 to March 2008, for an indication of trauma, in subjects with chronological age (CA) up to 216 months, were reviewed by two radiologists blinded to CA. Subjects ever investigated for metabolic, growth or nutritional disorders were excluded. SA was assessed according to GP atlas. To establish inter-observer reliability, 100 random radiographs were dually evaluated. Both sexes were divided into four subgroups. For each subgroup, difference between skeletal and chronological age was calculated. (paired t-test, alpha < 0.05).
  
  
  RESULTS
  Total 889 radiographs were analyzed. Inter-observer correlation coefficient was 0.992 (p < 0.001). Mean differences of up to 13 months between SA and CA were documented. The differences were statistically significant in all groups except adolescent males.
  
  
  CONCLUSIONS
  Our findings suggest against the applicability of GP atlas for accurate SA assessment in Pakistani children.
authors.affiliation: Department of Diagnostic Imaging, Warren-Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: Abdul Mueed
authors.initials: AM
authors.lastname: Zafar
authors.forename: Naila
authors.initials: N
authors.lastname: Nadeem
authors.forename: Yousuf
authors.initials: Y
authors.lastname: Husen
authors.forename: Muhammad Nadeem
authors.initials: MN
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton; D001271:Atlases as Topic; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D010154:Pakistan; D014953:Wrist / Q000000981:diagnostic imaging