title: The shorthand bone age assessment: a simpler alternative to current methods.
abstract: BACKGROUND
  Radiographic assessment of skeletal age in pediatric patients is a common practice among orthopaedic surgeons. Current methods of assessment remain labor intensive and require special resources. This study sought to investigate a novel, abridged method of bone age assessment that may serve as a simpler and more efficient alternative to the current standard.
  
  
  METHODS
  A shorthand bone age (SBA) method developed at our institution was compared against the Greulich and Pyle method from which it was derived. Standard left hand bone age radiographs of 140 male and 120 female patients, previously assigned skeletal ages ranging from 12.5 to 16 years in males and 10 to 16 years in females by musculoskeletal radiologists using the Greulich and Pyle radiographic atlas, were read using the shorthand method by 3 attending pediatric orthopaedic surgeons and an orthopaedic surgery resident. The shorthand method utilizes a single, univariable criterion for each age, rather than a multivariable subjective comparison to a radiographic atlas. All reviewers were blinded to the original bone age determination. Interobserver reliability, intraobserver reliability, and agreement with the previous records utilizing the atlas were calculated using weighted κ.
  
  
  RESULTS
  The SBA method readings demonstrated substantial agreement with readings by the Greulich and Pyle atlas, demonstrating weighted κ values ranging from 0.71 to 0.75. The SBA method also demonstrated substantial to almost perfect interobserver and intraobserver reliability, with values ranging from 0.77 to 0.87 and from 0.87 to 0.95, respectively.
  
  
  CONCLUSIONS
  These results are comparable or superior to previous reports which investigate the validity and reliability of other skeletal age assessment tools. The SBA assessment tool offers a simple and efficient alternative to current methods.
  
  
  METHODS
  Diagnostic study, level III.
authors.affiliation: Boston Children's Hospital, Boston, MA, USA.
authors.forename: Benton E
authors.initials: BE
authors.lastname: Heyworth
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Osei
authors.forename: Peter D
authors.initials: PD
authors.lastname: Fabricant
authors.forename: Robert
authors.initials: R
authors.lastname: Schneider
authors.forename: Shevaun M
authors.initials: SM
authors.lastname: Doyle
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Green
authors.forename: Roger F
authors.initials: RF
authors.lastname: Widmann
authors.forename: Stephen
authors.initials: S
authors.lastname: Lyman
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Burke
authors.forename: David M
authors.initials: DM
authors.lastname: Scher
mesh_terms: D000365:Age Determination by Skeleton / Q000379:methods*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D015588:Observer Variation; D015203:Reproducibility of Results; D016037:Single-Blind Method