title: Comment on Alquraini et al.: reliability of Canadian Emergency Department Triage and Acuity Scale (CTAS) in Saudi Arabia.
abstract: It is very common to examine reliability of triage scales using (weighted) kappa statistics. The point is that weighted kappa has grossly underestimated disagreements by one category and put more emphasis on extreme category disagreements; therefore, low prevalence of critically-ill and non-urgent patients has excluded the effect of extreme categories disagreement from calculated kappa coefficient and also contributed to significant overestimation. As a result, weighted kappa coefficient as an estimate of scale reliability is overestimated by the anchoring effect.
authors.affiliation: Evidence-Based Caring Research Center, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. mirhaghia@mums.ac.ir.|Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Chahrrah-e-Doktorha, Mashhad, Khorasan Razavi, Iran. mirhaghia@mums.ac.ir.
authors.forename: Amir
authors.initials: A
authors.lastname: Mirhaghi
keywords: Agreement; Emergency; Kappa; Reliability; Triage