BACKGROUND: Although the Australasian Triage Scale (ATS) has been developed two decades ago, its reliability has not been defined; therefore, we present a meta-analyis of the reliability of the ATS in order to reveal to what extent the ATS is reliable. DATA SOURCES: Electronic databases were searched to March 2014. The included studies were those that reported samples size, reliability coefficients, and adequate description of the ATS reliability assessment. The guidelines for reporting reliability and agreement studies (GRRAS) were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was done based on the method of moment's estimator. RESULTS: Six studies were included in this study at last. Pooled coefficient for the ATS was substantial 0.428 (95％CI 0.340–0.509). The rate of mis-triage was less than fifty percent. The agreement upon the adult version is higher than the pediatric version. CONCLUSION: The ATS has shown an acceptable level of overall reliability in the emergency department, but it needs more development to reach an almost perfect agreement.