The Greulich and Pyle atlas is used to estimate the age of children and adolescents. This systematic review summarizes the scientific evidence on the agreement between skeletal age from the Greulich and Pyle atlas (hereafter called GP skeletal age) and chronological age.

A total of 17 studies met our criteria. 13 studies presented results for GP skeletal age from chronological age, 2 presented results for chronological age from GP skeletal age and 2 were datasets which we used to present both types of results. These two approaches are not comparable and we have therefore conducted two separate analyzes.

The difference between GP skeletal age and chronological age was on average rarely more than one year for each age group.

The studies that presented the distribution of chronological age from GP skeletal age are the most relevant if the Greulich and Pyle atlas is used for age estimation. Here we did no meta-analysis, since results from three of the four studies were so affected by the phenomenon "age mimicry" that we do not have confidence in the results. We considered that only one study was conducted in such a way that it can adequately describe the method's ability to estimate age.

(New version published July 3, 2017. Updated analyses based on corrected and reviewed data. The changes have not affected the conclusion.)