Forensic age estimation using computed tomography of the medial clavicular epiphysis in a Tunisian population sample

Background: A computed tomography (CT) scan of the medial clavicular epiphysis plays an important role in age estimation. Our study aimed to validate thin-section CT scan images of the medial clavicular epiphysis according to the Schmeling and Kellinghaus methods in a Tunisian population sample and assess its reproducibility. Results: We examined 196 thoracic CT scans of Tunisian individuals aged under 40 years (126 males, 70 females), carried out in the Radiology Department of Ibn El Jazzar University Hospital in Kairouan, Tunisia, from September 1 ^st , 2017, to April 30 ^th , 2019, with a slice thickness of 0.6 mm. The mean age was 22.2 ± 7.36 SD, with extremes ranging from 3 to 40 years. The majority of the patients were male (64.3% vs. 35.7%) with no significant age difference between the two groups (p = 0.975). Stage 1 excludes the age of the majority of male subjects. Stage 3c is a good predictor for estimating the age of the majority of both sexes. Statistically significant positive correlation was found between age and determined stage based on Spearman’s rank correlation values (total group: rho = 0.854, p < 0.001). No significant age difference was noticed between the two clavicles or between the sexes. Inter-observer and intra-observer agreements were good. Conclusions: Through our study, we have established a frame of reference, and we can conclude that the CT study of the development of the medial clavicular epiphysis represents a reliable method for age estimation in the Tunisian population.