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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 32-35

Estimation of age from medial clavicle radiological ossification staging in a regional population of Eastern India


1 Department of Forensic and State Medicine, Calcutta National Medical College, Kolkata, West Bengal, India
2 Department of Forensic Medicine and Toxicology, NRS Medical College, Kolkata, West Bengal, India

Date of Submission11-Dec-2019
Date of Decision16-Jan-2020
Date of Acceptance30-May-2020
Date of Web Publication13-Feb-2021

Correspondence Address:
Saikat Das
Calcutta National Medical College, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjfms.sjfms_7_19

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  Abstract 


Background: Previous studies on medial clavicular epiphysis for age estimation using X ray have shown different results among the Spanish population, German population, and others. Studies with adequate sample size, involving the East Indian (Bengali) population, has not been found, based on which our objective of performing this study was decided. Subject and Method: Our study conducted among patients who were brought for examination of the chest due to various medical reasons, 200 cases were selected randomly after considering the inclusion and exclusion criteria from age 10 to 26 years, and clavicular ossification stage was determined by three observers by studying X ray images. Results: it is seen that the mean age for achieving Stage 3 in males is 17.50 years and females is 16.73 years. This can be significant from the point of view of declaring a person juvenile as per the various laws applicable. Conclusion: These results from our study signify that from the forensic point of view, the epiphyseal cartilage of the medial end of the clavicle can be of corroborative significance in assessment of age in doubtful cases of crime accused and in cases of immigration.

Keywords: Age determination, forensic, medial clavicular epiphysis, X-ray


How to cite this article:
Chowdhuri S, Ghosh A, Das S, Ghosh R, Bose TK. Estimation of age from medial clavicle radiological ossification staging in a regional population of Eastern India. Saudi J Forensic Med Sci 2019;2:32-5

How to cite this URL:
Chowdhuri S, Ghosh A, Das S, Ghosh R, Bose TK. Estimation of age from medial clavicle radiological ossification staging in a regional population of Eastern India. Saudi J Forensic Med Sci [serial online] 2019 [cited 2021 Dec 2];2:32-5. Available from: https://www.sjfms.org/text.asp?2019/2/2/32/309348




  Introduction Top


In forensic medicine, age estimation from the ossification of bones is of great importance.[1] This is due to growing population, increasing immigration, and massive undocumented birth rate. Several studies have been published on this topic. These studies have mostly used traditional methods of anthropology and thorough examination of bones of the dead.[1],[2],[3],[4] Advanced methods involving X-ray and computed tomography scan have been used to produce better results. This is largely attributed to the high quality of images used.[5] In this regard; studying the radiographs of medial clavicular epiphysis for estimation of age has proved to be useful.

Different ethnic groups show different growth patterns due to variation in their surrounding environments and genes. As for example, previous studies on medial clavicular epiphysis have shown different results among the Spanish population,[6] German population,[7],[8] and others.[9],[10],[11],[12] For this reason, it is important to note the ossification stages of bones in different ethnic groups.

Studies involving the East Indian (Bengali) population using advanced methods have not been found up to this date with adequate sample size. Thus, we have attempted to determine age using such advanced technique. In our study, X-ray plates of medial clavicular epiphysis have been used to determine age in case of the East Indian (Bengali) population.


  Methodology Top


Study subjects

The present work has been conducted by the examiners of the Department of Forensic and State Medicine of Calcutta National Medical College, Kolkata. Ten months was the study period. The study was conducted on 200 patients (102 males and 98 females) brought for chest X-ray (PA view) examination at Calcutta National Medical College. Proper informed consent was taken from the patients or their next of kin. Ethical clearance was taken from the Ethics Committee of Calcutta National Medical College; no additional radiation was given to the study participants.

The cases taken were according to the inclusion criteria:

  1. Age between 10 and 26 years at the time of the X-ray examination (medico-legally significant age group)
  2. Good quality radiographs
  3. Stable hemodynamic status and normal chest radiographs of the individuals.


Exclusion of certain cases was based on the following criteria:

  1. Patients suffering from congenital, endocrine, structural, or other serious diseases
  2. Overlapping or unclear radiograph.


Methods

Medial clavicular ossification stage was determined by three observers under the supervision of the radiologist of the X-ray center. The ossification stages of epiphyseal cartilage of the medial side of the clavicle from the X-ray images were noted [Figure 1]. The degree of ossification was classified[12] into five grades as follows:
Figure 1: X-ray image of clavicle showing ossification

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  1. Grade 1: Invisible ossification center
  2. Grade 2: Visible ossification center without any ossification of epiphyseal cartilage
  3. Grade 3: Visible ossification center with partial ossification of epiphyseal cartilage
  4. Grade 4: Complete ossification of epiphyseal cartilage with epiphyseal scar
  5. Grade 5: Complete ossification of epiphyseal cartilage without epiphyseal scar.


Statistical analysis

Data analysis was performed using SPSS (Statistical Package for the Social Sciences) software (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). Chi-square tests, analysis of variance (ANOVA), and post hoc tests were used in the study. P < 0.05 was considered statistically significant. Results are expressed in the form of tables, and similarities with other studies are discussed.


  Results Top


In this study, there were a total of 200 study participants, of which 102 were male and 98 were female. The minimum age among the study participants was 10 years and the maximum age was 26 years. The mean age for male patients was 19.54 years. In case of female patients, the mean age was 19.99 years.

Our study was conducted among patients brought for examination of the chest due to various medical reasons. Two hundred cases were selected randomly after considering the inclusion and exclusion criteria between 10 and 26 years of age. Cohen's kappa statistics showed good intraobserver and interobserver agreements.

On statistical analysis, we obtained the following results from the sample. The distribution of population was 35 cases in the 10–15 years' age group; 86 cases in the 16–21 years' age group and 79 cases in the 22–26 years' age group. Grading of ossification at the epiphyseal cartilage of medial clavicle was done among the 200 selected cases. On analysis, it was found that 16 cases were Stage 2, 54 cases were Stage 3, 78 cases were Stage 4, and 52 cases were Stage 5, as shown in [Table 1]. No variability of medial clavicular epiphyseal ossification was found between right and left clavicles. We also correlated the stages as per the grading of ossification at the epiphyseal cartilage of medial clavicle with the age groups in the population. As shown in [Table 1], most of the cases in the age group of 22–26 years were Stage 5. We can also see that the Chi-square test value is significant (P < 0.001). From [Table 2], we can see that the mean age for achieving Stage 3 is 17.50 years in males and 16.73 years in females. In case of Stage 4, it is 20.02 years in males and 20.13 years in females. Moreover, in case of Stage 5, it is 24.11 years in males and 24.61 years in case of females. The ANOVA test [Table 3] performed on the sample showed the significance value, P = 0.00 (P < 0.05). The post hoc test is demonstrated in [Table 4] to allow the comparison between the different age groups. The mean difference is found to be significant below 0.05 level for all age groups. Graph of mean age versus ossification grade is shown in [Figure 2].
Table 1: Age group × grade × sex cross tabulation

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Table 2: Comparing values

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Table 3: ANOVA

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Table 4: Post hoc test

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Figure 2: Graph of mean age versus ossification grade

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  Discussion Top


The grading of ossification at the epiphyseal cartilage of medial clavicle has rarely been explored as a tool for forensic purposes. In our study, we have tried to demonstrate the importance of this sign in forensic estimation of chronological age. This is the first study of its type in the Eastern Indian population. In our study, the degree of epiphyseal ossification of medial clavicle showed that the averaged ossification grades increased with increasing age between 10 and 26 years of age.

In forensic practice, the most crucial question from the medico-legal point of view is the determination of minimum age at which the ossification of epiphyseal cartilage of medial clavicle is completed. Previous radiological studies concur in establishing 22 years as the minimum age for the total fusion of that epiphysis. It can be seen from our study that the mean age for achievement of Stage 5 in both genders is 24 years. This is slightly different from the findings of the study done by Schmeling et al. (2004)[9] which showed that the minimum age for achieving Stage 5 in both genders was 26 years. In our study, Stage 4 was achieved in both genders at 20 years. This is in contrast with the previous study which showed the achievement of Stage 4 in males at 21 years and in case of females at 20 years. These age thresholds show similarity to the anatomical studies done by Owings Webb and Myers Suchey[10] and Ji et al. (1994).[11] According to the study by Kreitner et al.,[13] radiology is more likely to detect ossification than naked-eye observation during autopsy. From our study, it is seen that the mean age for achieving Stage 3 is 17.50 years in males and 16.73 years in females. This can be significant from the point of view of declaring a person juvenile as per the various laws applicable.

However, conventional radiography of the clavicle is often plagued by overlapping shadows produced by structures of the mediastinum, the vertebrae, and the ribs. This results in inaccurate visualization of the medial epiphysis and thus cannot be used for staging the extent of maturation.[14] Hence, other highly accurate methods studying bone ossifications[15],[16],[17] and viscera[18] are recommended for future researches.


  Conclusion Top


We can conclude that plain chest radiography has a significant but limited role in forensic age estimation. The data of the present study supplement the existing database. It also facilitates advanced possibilities of diagnosis of 17 years or 24 years of age. This can be of importance in various cases of doubtful age in heinous crimes and unaccompanied minor refugees in cases of unlawful immigration. From previous studies, it has been seen that the reference values of a particular ethnic race are determined by the socioeconomic status of the population. If a reference value from a socioeconomically advanced population is applied to populations from a weaker socioeconomic background, then there will be underestimation of the calculated ages. It can lead to injustice being meted out to the person concerned. Hence, a study on ethnic regional population is very important.



 
  References Top

1.
Schmeling A, Olze A, Reisinger W, Geserick G. Age estimation of living people undergoing criminal proceedings. Lancet 2001;358:89-90.  Back to cited text no. 1
    
2.
Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, et al. Criteria for age estimation in living individuals. Int J Legal Med 2008;122:457-60.  Back to cited text no. 2
    
3.
Schmeling A, Kaatsch HJ, Marr B, Reisinger W, Riepert T, Ritz-Timme S, et al. Study Group of Forensic Age Estimation of the German Association of Forensic Medicine. Guidelines for Age Estimation in Living Individuals in Criminal Proceedings; 2001. Available from: http://rechtsmedizin.klinikum.uni-muenster.de/agfad/empfehlungen.htm. [Last accessed on 2009 Jun 21].  Back to cited text no. 3
    
4.
Chowdhuri S, Mukhaopadhay PP. Estimation of stature from radiological measurement of sternal length with corroboration in living individuals a study in contemporary bengali adults. J Indian Acad Forensic Med 2015;34:388-91.  Back to cited text no. 4
    
5.
Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, et al. Criteria for age estimation in living individuals. Int J Legal Med 2008;122:457-60.  Back to cited text no. 5
    
6.
Garamendi PM, Landa MI, Botella MC, Alemán I. Forensic age estimation on digital X-ray images: Medial epiphyses of the clavicle and first rib ossification in relation to chronological age. J Forensic Sci 2011;56 Suppl 1:S3-12.  Back to cited text no. 6
    
7.
Wittschieber D, Ottow C, Schulz R, Püschel K, Bajanowski T, Ramsthaler F, et al. Forensic age diagnostics using projection radiography of the clavicle: A prospective multi-center validation study. Int J Legal Med 2016;130:213-9.  Back to cited text no. 7
    
8.
Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G. Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 2004;118:5-8.  Back to cited text no. 8
    
9.
Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G. Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 2004;118:5-8.  Back to cited text no. 9
    
10.
Owings Webb PA, Myers Suchey J. Epiphyseal union of the anterior iliac crest and medial clavicle in an modern multiracial sample of American males and females. Am J Phys Anthropol 1985;68:457-66.  Back to cited text no. 10
    
11.
Ji L, Terazawa K, Tsukamoto T, Haga K. Estimation of age from epiphyseal union degrees of the sternal end of the clavicle. [Hokkaido igaku zasshi] The Hokkaido Journal Of Medical Science 1994;69:104.  Back to cited text no. 11
    
12.
Bassed RB, Drummer OH, Briggs C, Valenzuela A. Age estimation and the medial clavicular epiphysis: Analysis of the age of majority in an Australian population using computed tomography. Forensic Sci Med Pathol 2011;7:148-54.  Back to cited text no. 12
    
13.
Kreitner KF, Schweden F, Schild HH, Riepert T, Nafe B. Die computertomographisch bestimmte Ausreifung der medialen Klavikulaepiphyse – Eine additive Methode zur Altersbestimmung im Adoleszentenalter und in der dritten Lebensdekade? Fortschr Röntgenstr 1997;166:481-6.  Back to cited text no. 13
    
14.
Manzoor Mughal A, Hassan N, Ahmed A. Bone age assessment methods: A critical review. Pak J Med Sci 2014;30:211-5.  Back to cited text no. 14
    
15.
Chowdhuri S, Das S, Ghosh R, Patra SS, Thassu I. Study of multidetector computed tomography images of the frontal sinuses for human identification: A study in regional Indian population. Int J Forensic Odontol 2019;4:73-6.  Back to cited text no. 15
  [Full text]  
16.
Chowdhuri S, Bhattacharjee R, Das S, Ghosh R. A Study to estimate forensic age by kreitner and kellingaus main stages method from epiphyseal ossification of the iliac crest by digital radiography. Saudi J Forensic Med Sci 2018;1:51-4.  Back to cited text no. 16
  [Full text]  
17.
Chowdhuri S, Biswas A, Das S, Ghosh R, Mukhopadhayay P, Dutta SK, Kundu B. Using multi detector computed tomography of the maxillary sinuses as an aid in identification in contemporary Indian (Bengali) population-a pilot study. Indian J Forensic Med Toxicol 2019;13:125-9.  Back to cited text no. 17
    
18.
Das S, Ghosh R, Chowdhuri S. A novel approach to estimate age and sex from MRI measurement of liver dimensions in an Indian (Bengali) Population – A pilot study. J Forensic Sci Med 2019;5:177-80.  Back to cited text no. 18
  [Full text]  


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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