Ignite Creation Date:
2024-05-06 @ 12:27 AM
Last Modification Date:
2024-10-26 @ 10:50 AM
Study NCT ID:
NCT01577498
Status:
COMPLETED
Last Update Posted:
2016-06-10
First Post:
2012-03-30
Brief Title:
Age Estimation of Adolescents for Legal Purposes
Sponsor:
Assistance Publique - Hôpitaux de Paris
Organization:
Assistance Publique - Hôpitaux de Paris
Study Overview
Official Title:
Age Estimation of Adolescents for Legal Purposes Determining the Medical Response
Status:
COMPLETED
Status Verified Date:
2016-05
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
AGE-ADO
Brief Summary:
Economic globalisation has been associated with a rise of cross-border migration in Europe In France courts commonly demand appropriate medical tests aimed at age estimations of supposed minors without documentation Determining the age of foreign adolescents may be important in order to define the rights and protection afforded them by law depending on this status and the conditions in which they may be detained or held in police custody if they are under suspicion Age estimation is considered to be ideally based on the combination of clinical skeletal and dental examinations A number of forensic physicians do not integrate published recommendations or the results of published studies into their daily practice Previous studies have shown that medical practice is heterogeneous in this area Factors determining this heterogeneity are unknown
We hypothesize that the personal and professional development of the physician as well as the characteristics and the circumstances of medical examination can affect medical response on age determination beyond clinical and radiological data The purpose of this study is to identify factors determining medical response to courts
We hypothesize that the personal and professional development of the physician as well as the characteristics and the circumstances of medical examination can affect medical response on age determination beyond clinical and radiological data The purpose of this study is to identify factors determining medical response to courts
Detailed Description:
Economic globalisation has been associated with a rise of cross-border migration in Europe Courts commonly demand appropriate medical tests aimed at age estimations of supposed minors without documentation Determining the age of foreign adolescents may be important in order to define the rights and protection afforded them by law depending on this status and the conditions in which they may be detained or held in police custody if they are under suspicion
Guidelines for age estimation in living individuals have been proposed and are based on the combination of general clinical skeletal and dental examinations However guidelines for paediatricians in the UK and a national consensus conference in France on doctors attendance on detainees in police custody have stated that the currently available methods generally do not enable a doctor to state with confidence if a detainee is a minor or not The validity of currently used methods has also been questioned by the French National Consultative Ethics Committee on Health and Life Sciences
As any middle school teacher can testify anthropometric measures such as height and weight and visible signs of sexual maturity vary widely from one adolescent to another so that general clinical examination has limited value for age estimation The skeletal examination is considered more reliable In the reference radiological method X-ray examination of the left hand and wrist is compared with standard images from an atlas published by Greulich and Pyle who collected standards obtained in the 1930s and 1940s from an American white middle-class population The main criteria applied for dental age determination are the eruption and development of the third molars based on external and X-ray examination
Age estimation is considered to be ideally based on the combination of clinical skeletal and dental examinations However it is not easy to determine from available published series if the estimated age of a given individual is a precise age or a spectrum of possible ages and in this case how broad is the proposed spectrum Indeed the information in the radiological atlas by Greulich and Pyle is statistical not individual The use of such data for forensic purposes has never been intended by the authors nor validated Moreover the ethnic and socioeconomic characteristics of the adolescents examined today in Western Europe may differ largely from those presented in the atlas as previously suggested The role of ethnic factors in skeletal maturation has been repeatedly studied and gave conflicting results In most series evaluating skeletal age in different populations hand and wrist X-rays were obtained from healthy subjects or patients received for evaluation of trauma The conclusions of these studies may not be validated or at least should be considered cautiously when extrapolating results to adolescents without documents involved in judicial procedures who have heterogeneous and largely unevaluated psychological and socioeconomic characteristics A number of forensic physicians do not integrate published recommendations or the results of published studies into their daily practice Previous studies have shown that medical practice is heterogeneous in this area Factors determining this heterogeneity are unknown
We hypothesize that the personal and professional development of the physician as well as the characteristics and the circumstances of medical examination can affect medical response on age determination beyond clinical and radiological data The main objective of this study is to identify factors determining medical response to courts A secondary objective is to evaluate how evidence-based data obtained from medical journals are taken into account in medical decision making by forensic physicians
The main evaluated criterium is the medical response transmitted to courts regarding age determination
Methods Prospective observational study of 500 age determinations requested by courts in migrant adolescents without documentation in 18 departments of forensic medicine in France Non-inclusion criterium is the refusal of the adolescent to undergo a medical examination
Guidelines for age estimation in living individuals have been proposed and are based on the combination of general clinical skeletal and dental examinations However guidelines for paediatricians in the UK and a national consensus conference in France on doctors attendance on detainees in police custody have stated that the currently available methods generally do not enable a doctor to state with confidence if a detainee is a minor or not The validity of currently used methods has also been questioned by the French National Consultative Ethics Committee on Health and Life Sciences
As any middle school teacher can testify anthropometric measures such as height and weight and visible signs of sexual maturity vary widely from one adolescent to another so that general clinical examination has limited value for age estimation The skeletal examination is considered more reliable In the reference radiological method X-ray examination of the left hand and wrist is compared with standard images from an atlas published by Greulich and Pyle who collected standards obtained in the 1930s and 1940s from an American white middle-class population The main criteria applied for dental age determination are the eruption and development of the third molars based on external and X-ray examination
Age estimation is considered to be ideally based on the combination of clinical skeletal and dental examinations However it is not easy to determine from available published series if the estimated age of a given individual is a precise age or a spectrum of possible ages and in this case how broad is the proposed spectrum Indeed the information in the radiological atlas by Greulich and Pyle is statistical not individual The use of such data for forensic purposes has never been intended by the authors nor validated Moreover the ethnic and socioeconomic characteristics of the adolescents examined today in Western Europe may differ largely from those presented in the atlas as previously suggested The role of ethnic factors in skeletal maturation has been repeatedly studied and gave conflicting results In most series evaluating skeletal age in different populations hand and wrist X-rays were obtained from healthy subjects or patients received for evaluation of trauma The conclusions of these studies may not be validated or at least should be considered cautiously when extrapolating results to adolescents without documents involved in judicial procedures who have heterogeneous and largely unevaluated psychological and socioeconomic characteristics A number of forensic physicians do not integrate published recommendations or the results of published studies into their daily practice Previous studies have shown that medical practice is heterogeneous in this area Factors determining this heterogeneity are unknown
We hypothesize that the personal and professional development of the physician as well as the characteristics and the circumstances of medical examination can affect medical response on age determination beyond clinical and radiological data The main objective of this study is to identify factors determining medical response to courts A secondary objective is to evaluate how evidence-based data obtained from medical journals are taken into account in medical decision making by forensic physicians
The main evaluated criterium is the medical response transmitted to courts regarding age determination
Methods Prospective observational study of 500 age determinations requested by courts in migrant adolescents without documentation in 18 departments of forensic medicine in France Non-inclusion criterium is the refusal of the adolescent to undergo a medical examination
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None