Systematic review on age assessment using Schmeling and Kellinghaus scoring of the medial end of the clavicle by various diagnostic imaging techniques

Abstract

Estimating age is crucial in legal cases to determine if an individual has reached adulthood, with the medial clavicular epiphysis being the last skeletal part to ossify. X-rays, CT scans, and MRIs are commonly used to assess it, making the evaluation of their accuracy important. This review, adhering to PRISMA guidelines, analyses studies from PubMed, ScienceDirect, and Google Scholar published between 1990 and 2024. Of the 1927 articles initially identified, 32 met the inclusion criteria after screening. Two authors independently conducted the screening process as part of the study selection. A spreadsheet was used for data extraction, and the QUADAS-2 tool was utilized for quality assessment. The study findings indicate that CT scans provide the highest accuracy for age determination in late adolescence and early adulthood due to better imaging resolution. MRI is promising as a non-X-ray alternative, especially when combined with hand/wrist evaluations. Although useful, X-rays have their limitations. Overall, the review suggests that advancing imaging techniques, particularly CT scans, represent the most accurate method for forensic age evaluation from the medial end of the clavicle in late teens and early adolescents, and that establishing population-specific standards is also essential for improving age estimation in forensic and legal contexts.