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Journal of Tropical Pediatrics 2000 46(3):132-139; doi:10.1093/tropej/46.3.132
© 2000 by Oxford University Press
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Radiographic scoring method for the assessment of the severity of nutritional rickets

TD ThacherA, PR FischerB,Z, JM PettiforC, JO LawsonD, BJ ManasterE and JC ReadingF

A Department of Family Medicine, D Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria B Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street, SW, Rochester, Minnesota 55905, USA C MRC Mineral Metabolism Research Unit, Department of Paediatrics, University of Witwatersrand and Chris Hani Baragwanath Hospital, Johannesburg, South Africa E Department of Radiology, University of Colorado, Denver, CO, USA F Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA Z Corresponding author

Radiographic changes of rickets are well characterized, but no method of grading the severity of these changes has been in general use. Consequently, it is difficult to compare objectively or follow radiographic improvement. We prospectively evaluated the utility and reproducibility of a scoring method for measuring the severity of rickets. A 10-point score for radiographs of wrists and knees was devised to assess the degree of metaphyseal fraying and cupping and the proportion of the growth plate affected. The score progresses in half point increments from zero (normal) to 10 points (severe). Four trained physicians independently scored radiographs on two separate occasions from 67 children with active rickets. A broad representation of mean radiographic scores was moderately correlated with alkaline phosphatase (r=0.58). Interobserver correlation of radiographic scores was 0.84 or greater for all observer pairs and intraobserver correlation was 0.89 or greater for each observer. Researchers and clinicians should find the score useful to assess objectively the severity of rickets.


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