title: Bone age in the 21st century: is Greulich and Pyle's atlas accurate for Israeli children?
abstract: BACKGROUND
  The applicability today of Greulich and Pyle's Radiographic Atlas of Skeletal Development of the Hand and Wrist (G&P) is uncertain.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether G&P is accurate in Israeli children today.
  
  
  METHODS
  Left-hand radiographs of 679 children (375 boys) ranging in age from 1 day to 18 years old were obtained for trauma in the period 2001-2009 and were evaluated for bone age according to G&P. Individual bone age was plotted against calendar age and smoothed to obtain the association between calendar age and bone age. Any difference was assessed with Wilcoxon signed-rank test.
  
  
  RESULTS
  In girls, there was no significant difference between bone age and calendar age (P = 0.188). G&P underestimated bone age in boys <15 years old (median difference, 2.3 months; P < 0.0001) and overestimated bone age in boys ≥15 years old (median difference, 2.9 months; P = 0.0043). The largest median difference (5.4 months; P = 0.0003) was seen in boys 6-10 years old.
  
  
  CONCLUSIONS
  The differences between calendar age and bone age according to G&P were relatively small compared with normal variance and are unlikely to be of clinical importance.
authors.affiliation: Pediatric Imaging, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. Michalle.soudack@sheba.health.gov.il
authors.forename: Michalle
authors.initials: M
authors.lastname: Soudack
authors.forename: Aviva
authors.initials: A
authors.lastname: Ben-Shlush
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jacobson
authors.forename: Lisa
authors.initials: L
authors.lastname: Raviv-Zilka
authors.forename: Iris
authors.initials: I
authors.lastname: Eshed
authors.forename: Orit
authors.initials: O
authors.lastname: Hamiel
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton / Q000379:methods* / Q000592:standards*; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D050276:Hand Bones / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008297:Male; D008953:Models, Anatomic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017678:Sex Distribution