The Validation of the Greulich and Pyle Atlas for Radiological Bone Age Assessments in a Pediatric Population from the Canary Islands

Bone age assessments measure the growth and development of children and adolescents by evaluating their skeletal maturity, which is influenced by various factors like heredity, ethnicity, culture, and nutrition. The clinical standards for this assessment should be up to date and appropriate for the specific population being studied. This study validates the GP-Canary Atlas for accurately predicting bone age by analyzing posteroanterior left hand and wrist radiographs of healthy children (80 females and 134 males) from the Canary Islands across various developmental stages and genders. We found strong intra-rater reliability among all three raters, with Raters 1 and 2 indicating very high consistency (intra-class coefficients = 0.990 to 0.996) and Rater 3 displaying slightly lower but still strong reliability (intra-class coefficients = 0.921 to 0.976). The inter-rater agreement was excellent between Raters 1 and 2 but significantly lower between Rater 3 and the other two raters, with intra-class coefficients of 0.408 and 0.463 for Rater 1 and 0.327 and 0.509 for Rater 2. The accuracy analysis revealed a substantial underestimation of bone age compared to chronological age for preschool- (mean difference = 17.036 months; < 0.001) and school-age males (mean difference = 13.298 months; < 0.001). However, this was not observed in females, where the mean difference was minimal (3.949 months; < 0.239). In contrast, the Atlas showed greater accuracy for teenagers, showing only a slight overestimation (mean difference = 3.159 months; = 0.823). In conclusion, the GP-Canary Atlas demonstrates overall precision but requires caution as it underestimates the BA in preschool children and overestimates it in school-age girls and adolescents.