Peri-pubertal Skeletal Age Determination using Sauvegrain’s Method in Indian Population

Abstract

Background: Skeletal age estimation provides a more accurate measure of biological maturation than chronological age, particularly during puberty when growth accelerates. The Greulich & Pyle (GP) method, though widely used, becomes less reliable in peri-pubertal children. The Sauvegrain method, based on elbow radiographs, has been proposed as a more precise alternative, but data on its applicability in Indian children are limited.

Aim: To evaluate the reliability and validity of the Sauvegrain method for peri-pubertal skeletal age determination in Indian children and compare it with the conventional GP method.

Methods:A cross-sectional observational study was conducted on 106 peri-pubertal children (53 boys, 53 girls) aged 9–15 years attending a tertiary teaching hospital (May 2023–November 2024). Skeletal age was assessed using elbow radiographs (Sauvegrain method) and wrist radiographs (GP method). Inter- and intra-observer reliability were evaluated. Correlation between skeletal age and chronological age was assessed using Pearson’s correlation coefficient.

Results: The mean chronological age was 13.21 ± 1.42 years in boys and 10.71 ± 1.39 years in girls. The Sauvegrain method consistently provided higher skeletal age estimates than the GP method. In boys, Sauvegrain scores correlated strongly with chronological age (r = 0.85–0.89), while in girls correlation was slightly lower (r = 0.78–0.82). The GP method showed a tendency to underestimate skeletal maturity. Reliability analysis confirmed excellent reproducibility, with interobserver intraclass correlation coefficients ranging from 0.89–0.91 and intraobserver coefficients from 0.87–0.91 (p < 0.001).

Conclusion: The Sauvegrain method demonstrated strong correlation with chronological age and superior reliability compared to the GP method, making it a valuable tool for peri-pubertal skeletal age determination in Indian children. Its structured scoring system minimizes observer variability and enhances accuracy, especially during pubertal growth. Larger, multicentric, and longitudinal studies are recommended to further validate its clinical utility.