BACKGROUND: Evaluation of skeletal maturity provides clinicians and researchers a window into the developmental progress of the skeleton. The FELS method for maturity assessment provides a point estimate and standard error based on 98 skeletal indicators. AIM: This paper outlines the statistical methodology used by the original FELS method and evaluates improvements that address the following: serial correlation in the calibration sample is now considered, a Bayesian estimation method is now employed to improve estimation near ages 0 and 18 years and uncertainty in the calibration due to sampling is now accounted for when computing confidence limits. SUBJECTS AND METHODS: The original FELS method was calibrated using 677 Fels Longitudinal Study participants. In the improved method, serial correlation is accounted for using GEE, a Bayesian analysis with a prior centred on chronological age is used and the bootstrap is used to account for all sources of variation. RESULTS: Accounting for serial correlation resulted in larger slopes for ordinal indicators. The Bayesian paradigm led to narrower confidence limits and a natural interpretation of skeletal age. Sampling variability in the calibration parameters was negligible. CONCLUSION: Improvements to the statistical basis of the FELS method provide a more effective method of estimating skeletal maturity.
BACKGROUND: Evaluation of skeletal maturity provides clinicians and researchers a window into the developmental progress of the skeleton. The FELS method for maturity assessment provides a point estimate and standard error based on 98 skeletal indicators. AIM: This paper outlines the statistical methodology used by the original FELS method and evaluates improvements that address the following: serial correlation in the calibration sample is now considered, a Bayesian estimation method is now employed to improve estimation near ages 0 and 18 years and uncertainty in the calibration due to sampling is now accounted for when computing confidence limits. SUBJECTS AND METHODS: The original FELS method was calibrated using 677 Fels Longitudinal Study participants. In the improved method, serial correlation is accounted for using GEE, a Bayesian analysis with a prior centred on chronological age is used and the bootstrap is used to account for all sources of variation. RESULTS: Accounting for serial correlation resulted in larger slopes for ordinal indicators. The Bayesian paradigm led to narrower confidence limits and a natural interpretation of skeletal age. Sampling variability in the calibration parameters was negligible. CONCLUSION: Improvements to the statistical basis of the FELS method provide a more effective method of estimating skeletal maturity.
Authors: William Cameron Chumlea; Christine M Schubert; Alex F Roche; Howard E Kulin; Peter A Lee; John H Himes; Shumei S Sun Journal: Pediatrics Date: 2003-01 Impact factor: 7.124
Authors: James O Sanders; Richard H Browne; Sharon J McConnell; Susan A Margraf; Timothy E Cooney; David N Finegold Journal: J Bone Joint Surg Am Date: 2007-01 Impact factor: 5.284
Authors: Alana M Munger; Kristin E Yu; Don T Li; Ryan J Furdock; Melanie E Boeyer; Dana L Duren; David R Weber; Daniel R Cooperman Journal: J Pediatr Orthop Date: 2021-08 Impact factor: 2.537