title: Use of Automated Bone Age for Critical Growth Assessment.
abstract: BACKGROUND
  We compared the variability of bone age (BA) rating between clinicians and an automated system in children with congenital adrenal hyperplasia (CAH).
  
  
  METHODS
  A total of 126 radiographs assessed by 3 clinicians blinded to patient details using Greulich and Pyle (GP) (readers 1, 2, and 3) and BoneXpert (BX).
  
  
  RESULTS
  Comparing BA rating with each other, the mean of the absolute differences varied from 0.42 ± 0.53 years (reader 1 and BX) to 0.57 ± 0.58 years (reader 2 and reader 3), P = .368. Comparing ratings that were consistent with all 4 methods (within 1 year of each other, 93/126, 74%) and the remaining, "outliers" (33/126, 26%), the outliers were younger (P = .003), smaller (height, P = .011, weight, P = .000), and prepubertal (P = .001).
  
  
  CONCLUSIONS
  The variability of BA rating in CAH children is similar whether performed by clinicians or an automated system. The greatest variability was in prepubertal children.
authors: MedStar Georgetown University Hospital, Washington, DC, USA khalid.m.khan@medstar.net.
authors: Khalid M
authors: KM
authors: Khan
authors: University of Minnesota, Minneapolis, MN, USA.
authors: Maria T
authors: MT
authors: Gonzalez-Bolanos
authors: University of Minnesota, Minneapolis, MN, USA.
authors: Tara
authors: T
authors: Holm
authors: University of Minnesota, Minneapolis, MN, USA.
authors: Bradley S
authors: BS
authors: Miller
authors: University of Minnesota, Minneapolis, MN, USA.
authors: Kyriakie
authors: K
authors: Sarafoglou
mesh_terms: D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000503:physiopathology*; D000365:Age Determination by Skeleton / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results
keywords: Greulich and Pyle; congenital adrenal hyperplasia; growth; prepubertal; puberty