International Journal of Legal Medicine

, Volume 132, Issue 5, pp 1415–1425 | Cite as

Forensic age estimation using computed tomography of the medial clavicular epiphysis: a systematic review

  • Coralie Hermetet
  • Pauline Saint-Martin
  • Arsène Gambier
  • Léo Ribier
  • Bénédicte Sautenet
  • Camille RérolleEmail author


Medicolegal physicians are increasingly called upon to aid in determining the administrative age group affiliation of refugees with questionable unaccompanied minor claims. According to guidelines for forensic age assessment, age differentiation along the 18-year-old cut-off relies on clavicular ossification. The thin-slice computed tomography scan (TSCTs) of the medial clavicular epiphysis (MCE) is one of the methods contributing to this assessment, though it is not yet universally accepted. The aim of this systematic review was to identify scientific papers where age was assessed using TSCTs of the MCE and to observe whether this examination was reproducible and reliable in estimating a person’s age relative to the 18-year-old threshold. A search algorithm was applied to several databases to identify articles in accordance with the PRISMA (Preferred Reporting Items for Systematic-Reviews and Meta-Analyses) statement. One boxplot per article was constructed, separating by stage of maturation and sex. The 13 articles selected represented a sample of 5605 individuals (3396 males, 2209 females) aged 10 to 35 years. All individuals classified as stages 4 and 5 were aged 18 years or older. The same result was obtained concerning stage 3c, except in one article. The results thus appear reliable and reproducible, in particular, with respect to the 18-year-old threshold; medicolegal physicians should be able to estimate that all individuals in stages 4 and 5 are at least 18 years old. Additional studies applied to several other populations in the world should complement the selected studies.


Systematic review Medial clavicular epiphysis Computed tomography Age estimation Age assessment Living individuals 



The authors would like to thank Ms. Qing Hong CAI, Xiangtan University, Xiangtan, Hunan, China, for her helpful and voluntary participation by translating the two original Chinese articles included in this work.

Compliance with ethical standards

Conflict of interest

Pauline Saint-Martin and Camille Rérolle were involved in the elaboration of the selected article, Houpert et al., as investigator, co-author, and corresponding author.

Coralie Hermetet, Arsène Gambier, Léo Ribier, and Bénédicte Sautenet do not have any conflicts of interest to declare.

Supplementary material

414_2018_1847_MOESM1_ESM.xlsx (13 kb)
Supplementary material ) (XLSX 13 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculté de médecineUniversité François-RabelaisToursFrance
  2. 2.Institut médico-légalCHRU ToursToursFrance
  3. 3.Pôle d’imagerie médicaleCHRU ToursToursFrance
  4. 4.Service de néphrologie et d′immunologie cliniqueCHRU ToursToursFrance

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