RESUMEN
OBJECTIVES: Many studies on subadult sex estimation focus on elements that express sexually dimorphic features in adults. In contrast, diaphyseal dimensions have been shown to display sex-specific differences prior to adolescence. The current study evaluates the use of diaphyseal dimensions in subadult sex estimation. MATERIALS AND METHODS: Eighteen postcranial measurements from six long bones were collected on Lodox Statscan radiographic images of 1,310 modern South African children between birth and 12 years of age. Linear (LDA) and flexible discriminant analysis (FDA) and logistic regression were employed with single and multiple variable models with age both included and excluded from the model. Bootstrapped cross-validation was employed because some of the multiple variable subsets had small sample sizes. Each of the bootstrapped accuracies has an associated 95% confidence interval demonstrating the ranges in classification. RESULTS: Classification methods utilizing multiple variables achieved the highest bootstrapped classification accuracies (70% to 93%). The inclusion of age in the models did not consistently increase or decrease the classification accuracies. Proximal and distal breadth measurements were consistently recognized as important measurements in model creation. FDA yielded the highest overall accuracies, but the logistic regression presented with overall smaller bootstrapped 95% confidence intervals. DISCUSSION: Quantifiable sex differences were discovered in the appendicular skeleton of children between birth and 12 years of age. The high classification accuracies were likely due to using numerous predictor variables from multiple skeletal elements, which were optimized for classification using FDA. To facilitate application, a graphical user interface, KidStats, was developed.
Asunto(s)
Huesos/anatomía & histología , Diáfisis/anatomía & histología , Determinación del Sexo por el Esqueleto/métodos , Antropología Física , Huesos/diagnóstico por imagen , Niño , Preescolar , Análisis por Conglomerados , Diáfisis/diagnóstico por imagen , Análisis Discriminante , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Radiografía , Caracteres Sexuales , SudáfricaRESUMEN
RATIONALE: Accurate weight measurements are essential for both growth monitoring and drug dose calculations in children. Weight can be accurately measured using calibrated scales in resource-rich settings; however, reliable scales are often not available in resource-poor regions or emergency situations. Current age and/or length/height-based weight-prediction equations tend to overestimate weight because they were developed from Western children's measures. OBJECTIVE: To determine the accuracy of several proxy measures for children's weight among a predominately HIV-positive group of children aged 18â months to 12â years in Botswana. DESIGN: Weight, length/height, ulna and tibia lengths, mid-upper arm circumference (MUAC) and triceps skinfold were measured on 775 children recruited from Gaborone, Botswana, between 6 July and 24 August 2011. RESULTS: Mean (95% CI) age and weight were 7.8â years (7.5 to 8.4) and 21.7â kg (21.2 to 22.2), respectively. The majority of children were HIV-positive (n=625, 81%) and on antiretroviral treatment (n=594, 95%). The sample was randomly divided; a general linear model was used to develop weight-prediction equations for one half of the sample (n=387), which were then used to predict the weight of the other half (n=388). MUAC and length/height, MUAC and tibia length and MUAC and ulna length most accurately predicted weight, with an adjusted R2 of 0.96, 0.95 and 0.93, respectively. Using MUAC and length/height, MUAC and tibia length and MUAC and ulna length equations, ≥92% of predicted weight fell within 15% of actual weight, compared with <55% using current equations. CONCLUSION: The development of nomograms using these equations is warranted to allow for rapid and accurate weight prediction from these simple anthropometric measures in HIV-endemic, resource-constrained settings.