Statistical rigor and kappa considerations: which, when and clinical context matters

We thank Maleki and Naderi¹ for their correspondence letter highlighting the methodological kappa optimal use in the March issue of Pediatric Research in response to “Interrater reliability of the modified Sarnat examination in preterm infants”.²

The key findings in late preterm infants 33−36 weeks of age who were evaluated in the first 6 h after birth with the modified Sarnat exam were the following: (1) The reliability between the gold standard study investigator and the group of attending neonatologists was good to excellent (k > 0.72) in most categories except for Moro and tone. (2) While the agreement was poor for both tone and Moro categories in infants born at 32–34 weeks’ gestation (k = 0.20–0.60), it dramatically improved at 35−36 weeks suggesting an important maturation effect.

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