Can we rely on adolescents to self-assess puberty stage? A systematic review and meta-analysis.

CONTEXT: Clinicians, researchers, and global health advocates often include pubertal development in outcomes. However, assessments of pubertal stage can be challenging because of the sensitive nature and feasibility of clinical examinations, especially in larger settings.
OBJECTIVE: To determine the accuracy of self-assessed Tanner staging when compared with physically assessed Tanner stages by a clinician. DATA SOURCES: MEDLINE, PubMed, Embase, Web of Science, Scopus, the Cochrane Library, CINAHL. STUDY SELECTION: Studies were included if they reported 5 × 5 tables of self-assessment compared to clinician-assessment for the 5-stage Tanner scale. DATA EXTRACTION: We extracted data to generate complete 5 × 5 tables for each study, including any subgroup eligible for the analysis, such as overweight/obese youth. DATA SYNTHESIS: After screening, 22 studies representing 21,801 participants met our inclusion criteria for the meta-analysis. Overall agreement was moderate or substantial between the 2 assessments, with breast stage 1, female pubic hair 1, male pubic hair 1, and male pubic hair 5 having the highest agreement. When stages were collapsed into pre- (Tanner stage 1), in (stages 2,3), and completing (stages 4,5) puberty, levels of agreement improved, especially for pre- and completing pubertal development. Most included studies comprised Caucasian youth. More studies are needed which include a broader range of geographic and socioeconomic settings, as well as a greater diversity of racial/ethnic groups.
CONCLUSIONS: Self-assessment of puberty is most accurate when identifying Tanner stage 1, Tanner stage 5 and when development is categorized into prepuberty, in, and completing puberty phases. Use of self-assessment data should be structured accordingly. PROTOCOL REGISTRATION: PROSPERO # CRD42018100205. © Endocrine Society 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.