Acceleration of skeletal maturation in Central Europe over the last two decades: insights from two cohorts of healthy children.

BACKGROUND: Deviations between the determination of bone age (BA) according to Greulich and Pyle (G&P) and chronological age (CA) are common in Caucasians. Assessing these discrepancies in a population over time requires analysis of large samples and low intra-observer variability in BA estimation, both can be achieved with artificial intelligence-based software. The latest software-based reference curve contrasting the BA determined by G&P to the CA of Central European children dates back over two decades. OBJECTIVE: To examine whether the reference curve from a historical cohort from the Netherlands (Rotterdam cohort) between BA determined by G&P and CA still applies to a current Central European cohort and derive a current reference curve. MATERIALS AND METHODS: This retrospective single-center study included 1,653 children and adolescents (aged 3-17 years) who had received a radiograph of the hand following trauma. The G&P BA estimated using artificial intelligence-based software was contrasted with the CA, and the deviations were compared with the Rotterdam cohort. RESULTS: Among the participants, the mean absolute error between BA and CA was 0.92 years for girls and 0.97 years for boys. For the ages of 8 years (boys) and 11 years (girls) and upward, the mean deviation was significantly greater in the current cohort than in the Rotterdam cohort. The reference curves of both cohorts also differed significantly from each other (P < 0.001 for both boys and girls). CONCLUSION: The BA of the current Central European population and that of the curve from the Rotterdam cohort from over two decades ago differ. Whether this effect can be attributed to accelerated bone maturation needs further evaluation.

Visceral obesity determined in routine preoperative CT scans predicts risk of postoperative burst abdomen.

Burst abdomen (BA) remains a severe postoperative complication after abdominal surgery. Obesity is a known risk factor for postoperative complications but objective parameters such as body mass index fail to predict BA after abdominal surgery. In recent literature, CT-derived body composition assessment could predict obesity-related diseases and surgical site infections. We report data from the institutional wound register, comparing patients with BA to a subgroup of patients without BA. The CT images were evaluated for intraabdominal and subcutaneous fat tissues. Univariate and multivariate risk factor analysis was performed in order to evaluate CT-derived obesity parameters as risk factor for BA. 92 patients with BA were compared to 32 controls. Patients with BA had significantly more visceral obesity (VO; p < 0.001) but less subcutaneous obesity (SCO) on CT scans. VO and SCO both were positively correlated with BMI (r = 0.452 and 0.572) but VO and SCO were inversely correlated (r = -0.189). Multivariate analysis revealed VO as significant risk factor for postoperative BA (OR 1.257; 95% CI 1.084-1.459; p = 0.003). Our analysis of patients with postoperative BA revealed VO as major risk factor for postoperative BA. Thus, preoperative CT scans gives valuable information on possible risk stratification.

Applicability and robustness of an artificial intelligence-based assessment for Greulich and Pyle bone age in a German cohort.

PURPOSE: The determination of bone age (BA) based on the hand and wrist, using the 70-year-old Greulich and Pyle (G&P) atlas, remains a widely employed practice in various institutions today. However, a more recent approach utilizing artificial intelligence (AI) enables automated BA estimation based on the G&P atlas. Nevertheless, AI-based methods encounter limitations when dealing with images that deviate from the standard hand and wrist projections. Generally, the extent to which BA, as determined by the G&P atlas, corresponds to the chronological age (CA) of a contemporary German population remains a subject of continued discourse. This study aims to address two main objectives. Firstly, it seeks to investigate whether the G&P atlas, as applied by the AI software, is still relevant for healthy children in Germany today. Secondly, the study aims to assess the performance of the AI software in handling non-strict posterior-anterior (p. a.) projections of the hand and wrist. MATERIALS AND METHODS: The AI software retrospectively estimated the BA in children who had undergone radiographs of a single hand using posterior-anterior and oblique planes. The primary purpose was to rule out any osseous injuries. The prediction error of BA in relation to CA was calculated for each plane and between the two planes. RESULTS: A total of 1253 patients (aged 3 to 16 years, median age 10.8 years, 55.7 % male) were included in the study. The average error of BA in posterior-anterior projections compared to CA was 3.0 (±â€Š13.7) months for boys and 1.7 (±â€Š13.7) months for girls. Interestingly, the deviation from CA tended to be even slightly lower in oblique projections than in posterior-anterior projections. The mean error in the posterior-anterior projection plane was 2.5 (±â€Š13.7) months, while in the oblique plane it was 1.8 (±â€Š13.9) months (p = 0.01). CONCLUSION: The AI software for BA generally corresponds to the age of the contemporary German population under study, although there is a noticeable prediction error, particularly in younger children. Notably, the software demonstrates robust performance in oblique projections. KEY POINTS: · Bone age, as determined by artificial intelligence, aligns with the chronological age of the contemporary German cohort under study.. · As determined by artificial intelligence, bone age is remarkably robust, even when utilizing oblique X-ray projections..