Juvenile sex estimation using the elevation of the auricular surface: A systematic review and meta-analysis

The development and identification of methods for effective sex estimation of physiologically juvenile remains continue to challenge bioarchaeologists. This systematic review and meta-analysis of investigates the diagnostic accuracy of auricular surface elevation (ASE) for sex estimation of physiological juveniles; determines how the diagnostic accuracy differs between the categorical ASE method and the adapted ranked ASE method; and assesses if the diagnostic accuracy of ASE sex estimation improves with age. ASE sex estimation is used as a component of puberty estimation. A forward search using Google Scholar, SCOPUS, and CrossRef identified 248 unique documents that cited Weaver's original description of the method. The results of more than 700 sex estimates from five peer-reviewed articles and two PhD dissertations are synthesized through bivariate meta-analysis. The bivariate meta-analysis reveals that ASE sex estimation correctly estimates sex of 36.7% [95% CI: 20.8–56.1%] of females and 82.4% [71.9–89.6%] of males. The predictive value of the female auricular surface trait (elevated) is 67.6% [61.8–72.9%], and the predictive value of the male trait (non-elevated) is 56.6% [54.3–58.8%]. When separated into age cohorts of under 1 year old, under 10 years old, and over 10 years old, ASE sex estimation did not show improvement with increased age. This analysis demonstrates that the ASE sex estimation method does not accurately estimate or predict sex of physiologically juvenile individuals, with no improvement from a ranked method or by age. Furthermore, this method should not be used as a component of puberty estimation due to lack of improvement with increasing age-at-death.