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Title: Reproducibility and inter-observer agreement of Greulich-Pyle protocol to estimate skeletal age among female adolescent soccer players
Authors: Faustino-da-Silva, Yuri V
Martinho, Diogo V. 
Coelho-e-Silva, Manuel J. 
Santos, João Valente dos 
Conde, Jorge 
Oliveira, Tomás G.
Ronque, Enio R. V.
Agostinete, Ricardo R.
Fernandes, Rômulo A.
Sherar, Lauren B.
Keywords: Youth sports; Female athlete; Biological maturation; Bone age; Atlas method
Issue Date: 26-Oct-2020
Publisher: Springer Nature
Project: uid/dtp/04213/2020] 
São Paulo Foundation FAPESP [2018/09230–2; 2019/15959–8] 
Serial title, monograph or event: BMC Pediatrics
Volume: 20
Issue: 1
Abstract: Background: Skeletal age (SA) is considered the best method of assessing biological maturation. The aim of this study was to determine intra-observer (reproducibility) and inter-observer agreement of SA values obtained via the Greulich-Pyle (GP) method. In addition, the variation in calculated SAs by alternative GP protocols was examined. Methods: The sample was composed of 100 Portuguese female soccer players aged 12.0–16.7 years. SAs were determined using the GP method by two observers (OB1: experience < 100 exams using GP; OB2: experience > 2000 exams using several methods). The radiographs were examined using alternative GP protocols: (wholeGP) the plate was matched to the atlas as an overall approach; (30-boneGP) bone-by-bone inspections of 30-bones; (GPpmb) bone-by-bone inspections of the pre-mature bones only. For the 30-boneGP and GPpmb approaches, SA was calculated via the mean (M) and the median (Md). Results: Reproducibility ranged 82–100% and 88–100% for OB1 and OB2, respectively. Inter-observer agreement (100 participants multiplied by 30 bones) was 92.1%. For specific bones, agreement rates less than 90% were found for scaphoid (81%), medial phalange V (83%), trapezium (84%) and metacarpal V (87%). Differences in wholeGP SAs obtained by the two observers were moderate (d-cohen was 0.79). Mean differences between observers when using bone-by bone SAs were trivial (30-boneGP: d-cohen less than 0.05; GPpmb: d-cohen less than 0.10). The impact of using the mean or the median was negligible, particularly when analyses did not include bones scored as mature. Conclusion: The GP appeared to be a reasonably reproduciblemethod to assess SA and inter-observer agreement was acceptable. There is evidence to support a recommendation of only scoring pre-mature bones during later adolescence. Further research is required to examine whether these findings are consistent in younger girls and in boys.
ISSN: 1471-2431
DOI: 10.1186/s12887-020-02383-4
Rights: openAccess
Appears in Collections:FCDEF - Artigos em Revistas Internacionais
I&D CIDAF - Artigos em Revistas Internacionais

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