Skull joints assessed via CT for age estimation-a systematic review.

Abstract

Objectives: To screen the existing scientific literature and to evaluate the reliability of skull joints as biological markers for age estimation when analysed via CT.

Methods: The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in Open Science Framework (DOI: 10.17605/OSF.IO/PCVEF). Eligible studies included observational cross-sectional research that assessed skull joints for age estimation through CT. Data from 5 databases were screened: Medline/PubMed, Scopus, LILACS, SciELO, and Open Grey. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews.

Results: A total of 15 studies out of 4633 initially screened were eligible. The studies tested age estimation based on the spheno-occipital joint (53.33%) and cranial sutures, namely coronal, sagittal, and lambdoid (46.66%). Multi-slice CT was the most commonly used imaging modality (66.66%), with a slice thickness of <1 mm in 93.33% of studies. All the studies that assessed the spheno-occipital joint endorsed its application for age estimation, but some (37.5%) stressed limitations. Four (57.14%) out of the 7 studies that assessed the cranial sutures raised concerns about their use for age estimation (3 advised against it). Most of the studies had a low risk of bias (86.66%).

Conclusion: Findings supported the forensic application of the spheno-occipital joint for age estimation in adolescents and young adults, despite variability in fusion age. Cranial sutures were largely discouraged as sole markers because of unsatisfactory accuracy and high error risks.