Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial.
Hu W, Tao C, Wang L, Chen Z, Li D, Chen W, Yi T, Xu L, Yu C, Wang T, Yao X, Cui T, Yuan G, Su J, Chen L, Zhou Z, Ma Z, Wang J, Wang B, Han H, Wang H, Chen J, Zhou P, Cao Z, Ren Y, Cai X, Shi H, Zhang G, Yu L, Yuan X, Li J, Zeng G, Ni C, Li T, Wu Y, Li Y, Li K, Liu Y, Wang Y, Jin Y, Liu H, Wen J, Sun J, Zhu Y, Li R, Zhang C, Liu T, Song J, Wang L, Cheng J, Qureshi AI, Nguyen TN, Saver JL, Nogueira RG, Liu X
- DOI
- 10.1136/bmj-2024-080489
- Record issued
- 2026-08-15
- Engine
- 7.39.0
- Exported
- 2026-09-20
Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/6db21fc1-176a-416a-8de0-79d7444af342 is authoritative.
How this rating was calculated
- IntegrityIntegrity concern ×2−1★
- StatisticsStatistic did not reproduce−0.5★
- ClaimsTreatment effect not shown to be clinically meaningful−0.5★
- StatisticsPrinted percentage does not match its own count (capped) ×4−0.25★
- ReportingData & code availability partially met−0.25★
- The numeric-impossibility checks (GRIM/GRIMMER/DEBIT/SPRITE) did not run: 8 reported means were read, and their group size is not stated where the values are printed (this source has no machine-readable table structure). These checks need the count the mean was averaged over, so none was performed.
- No data or code availability links were detected to verify.
- 01Printed percentage does not match its own count
8.3% does not match the reported count 8/104
“eight patients (8.3%) in the tenecteplase group”
ResultsFind in source - 02Treatment effect not shown to be clinically meaningful
The primary outcome showed no statistically significant difference (adjusted risk ratio 1.36, 95% CI 0.92 to 2.02; P=0.12). The absolute difference was 8.3 percentage points, but the confidence interval includes zero and the study was powered to detect an 18% absolute risk reduction. The effect is not statistically supported and lacks clinical meaningfulness.
“adjusted risk ratio 1.36, 95% confidence interval 0.92 to 2.02; P=0.12; adjusted absolute difference 8.3 percentage points, 95% CI −3.8 to 20.4”
- 03Printed percentage does not match its own count
3.1% does not match the reported count 3/104
“three (3.1%) in the control group”
ResultsFind in source - 04Printed percentage does not match its own count
69% does not match the reported count 144/208
“basilar artery in 144 (69%) patients”
ResultsFind in source - 05Printed percentage does not match its own count
5% does not match the reported count 10/208
“posterior cerebral artery in 10 (5%)”
ResultsFind in source - 06Printed percentage does not match its own count
69% does not match the reported count 72/104
“Large artery atherosclerosis | 72 (69.0)”
Table 1Find in source
This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.
This is a well-conducted randomised controlled trial with rigorous design, clear reporting of methods and results, and appropriate statistical analysis. The main weaknesses are a vague data availability statement and minor reporting gaps (outlier handling, reporting guideline adherence).
Both reviewers classified the study as interventional (RCT), and no divergence was present. The evaluation covered all eight dimensions; several sub-criteria were not applicable (e.g., animal-related, cell line, controls). The statistics verification component could only recompute a subset of tests; the absence of detected errors does not confirm overall statistical correctness.
Numerical inconsistencies
3 findings · worst highValues that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.
- Summary statistic impossible for the stated N (GRIM/GRIMMER)Recomputed
- Printed percentage does not match its own countRecomputed
- Internal contradictions in the reported numbersAssessed
Recomputed 2 tests: 2 consistent, 0 inconsistent; 1 recomputed directly from the reported test statistics, 1 via agent-written checks. 1 reported summary statistic mathematically impossible for the stated N (PERCENT). 4 printed percentages that do not match their own count.
- PERCENT8.3% does not match the reported count 8/104
“eight patients (8.3%) in the tenecteplase group”
ResultsFind in source - PERCENT3.1% does not match the reported count 3/104
“three (3.1%) in the control group”
ResultsFind in source - PERCENT69% does not match the reported count 144/208
“basilar artery in 144 (69%) patients”
ResultsFind in source - PERCENT5% does not match the reported count 10/208
“posterior cerebral artery in 10 (5%)”
ResultsFind in source - PERCENT69% does not match the reported count 72/104
“Large artery atherosclerosis | 72 (69.0)”
Table 1Find in source
- CONSISTENTreported p = .120 · recomputed p = .125Recomputed risk ratio 1.36 (95% CI 0.92–2.02), reported p=0.12
“risk ratio 1.36, 95% confidence interval 0.92 to 2.02; P=0.12”
Taken as given: 0.92–2.02 is a two-sided 95% confidence interval for the risk ratio of 1.36, not a range, an IQR, or a different interval level; the risk ratio is a RATIO measure, so the interval is symmetric on the log scale; p=0.12 is the p for THIS estimate, not for another comparison in the same sentenceMethod: back the two-tailed p out of the log-scale CI width and compare it against the printed pHow we recomputed it: pCI(1.36, 0.92, 2.02, 1) - CONSISTENTreported p = .120 · recomputed p = .108Reviewers 1, 2Symptomatic ICH risk ratio p-value from adjusted RR and 95% CI
“adjusted risk ratio 3.09, 95% CI 0.78 to 12.20”
Taken as given: The RR is on a log scale.; The CI is a 95% confidence interval.; The p-value is two-sided.Method: Recomputed p-value from the reported RR and 95% CI using the normal approximation for the log-RR.How we recomputed it: pCI(3.09, 0.78, 12.20, 1)
- lowinternal contradictionThe abstract reports 36 patients (34.6%) in the tenecteplase group and 27 (26.0%) in the control group for the primary outcome, but the discussion mentions a non-significant adjusted absolute difference of 7.6% favouring the tenecteplase group, while the results section reports an adjusted absolute difference of 8.3 percentage points. This discrepancy is minor and may be due to rounding or different adjustment models.
“as there was a non-significant adjusted absolute difference in the rates of 90 day modified Rankin scale score of 0 or 1 of 7.6% favouring the intra-arterial tenecteplase group”
LimitationsFind in source - lowinternal contradictionThe per-protocol analysis states 206 patients (81%), but 206/208 is 99%. This appears to be a typographical error.
“leaving 206 patients (81%) in the per protocol analyses”
MethodsFind in source
Overstated conclusions
1 finding · worst highConclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.
- Treatment effect not shown to be clinically meaningfulAssessed
5 major claims checked against the paper's own evidence: all adequately supported.
- supportedReviewer 1Intra-arterial tenecteplase after successful endovascular recanalisation did not improve 90-day excellent functional outcomes compared with endovascular treatment alone.The primary outcome analysis shows no statistically significant difference (adjusted RR 1.36, 95% CI 0.92-2.02, P=0.12), supporting the claim of no improvement.Evidence: Primary outcome result: 34.6% vs 26.0%, adjusted RR 1.36 (0.92-2.02), P=0.12.
“At 90 days, 36 patients (34.6%) in the tenecteplase group and 27 (26.0%) in the control group had a modified Rankin scale score of 0 or 1 (adjusted risk ratio 1.36, 95% confidence interval 0.92 to 2.02; P=0.12).”
AbstractFind in source - supportedReviewers 1, 2Symptomatic intracranial haemorrhage was numerically higher in patients receiving intra-arterial tenecteplase.The reported rates (8.3% vs 3.1%) and adjusted RR 3.09 (0.78-12.20) show a numerical increase, though not statistically significant.Evidence: Safety outcome: symptomatic ICH within 36 hours occurred in 8 (8.3%) vs 3 (3.1%), adjusted RR 3.09 (0.78-12.20).
“Symptomatic intracranial haemorrhage within 36 hours occurred in eight patients (8.3%) in the tenecteplase group and three (3.1%) in the control group (adjusted risk ratio 3.09, 0.78 to 12.20).”
AbstractFind in source - supportedReviewers 1, 290-day mortality did not differ between the groups.Mortality rates were similar (27.9% vs 26.9%) with adjusted RR 1.13 (0.73-1.74), supporting no significant difference.Evidence: Mortality at 90 days: 29 (27.9%) vs 28 (26.9%), adjusted RR 1.13 (0.73-1.74).
“Mortality at 90 days was similar between the tenecteplase and control groups: 29 (27.9%) v 28 (26.9%), adjusted risk ratio 1.13, 0.73 to 1.74.”
AbstractFind in source - supportedReviewer 1The trial was underpowered to detect a smaller but clinically meaningful difference.The sample size was calculated to detect an 18% absolute risk reduction, but the observed difference was smaller (8.3 percentage points), so the trial was indeed underpowered for smaller effects.Evidence: Sample size calculation assumed 20% vs 38% event rates; observed rates were 26% vs 34.6%.
“as there was a non-significant adjusted absolute difference in the rates of 90 day modified Rankin scale score of 0 or 1 of 7.6% favouring the intra-arterial tenecteplase group and the study was powered to show an absolute risk reduction of 18%, it is possible that the study was underpowered to find a smaller but still clinically meaningful difference.”
LimitationsFind in source - supportedReviewer 2Intra-arterial tenecteplase after successful endovascular recanalisation was not associated with a statistically significant reduction in combined disability and mortality at 90 days.The primary outcome analysis shows no statistically significant difference (adjusted RR 1.36, 95% CI 0.92-2.02, P=0.12), supporting the claim.Evidence: Primary outcome result: 34.6% vs 26.0%, adjusted RR 1.36 (0.92-2.02), P=0.12.
“In patients with acute ischaemic stroke due to acute posterior large or proximal vessel occlusion, intra-arterial tenecteplase administered after successful recanalisation was not associated with a statistically significant reduction in combined disability and mortality at 90 days.”
ConclusionFind in source
Premise concern: effect size not shown to be clinically meaningful.
- ADEQUATESurrogate endpointThe primary outcome is a hard clinical outcome: freedom from disability (modified Rankin scale score 0 or 1) at 90 days. This is a validated functional scale, not a surrogate biomarker.
“The primary outcome was freedom from disability (modified Rankin scale score 0 or 1) at 90 days after randomisation.”
- INADEQUATEEffect sizeThe primary outcome showed no statistically significant difference (adjusted risk ratio 1.36, 95% CI 0.92 to 2.02; P=0.12). The absolute difference was 8.3 percentage points, but the confidence interval includes zero and the study was powered to detect an 18% absolute risk reduction. The effect is not statistically supported and lacks clinical meaningfulness.
“adjusted risk ratio 1.36, 95% confidence interval 0.92 to 2.02; P=0.12; adjusted absolute difference 8.3 percentage points, 95% CI −3.8 to 20.4”
Data authenticity concerns
None foundAn adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.
Checked — nothing surfaced.
Reporting gaps
1 finding · worst mediumRequired detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.
- Data/code availability incompleteAssessed
The introduction cites the CHOICE trial and ATTENTION trial to establish the rationale for adjunctive intra-arterial thrombolysis. The hypothesis follows logically from the cited evidence. Limitations of prior work (e.g., anterior circulation focus) are acknowledged, and the study addresses the gap for posterior circulation.
“Adjunctive intra-arterial infusion of thrombolytic agents appeared promising for large vessel occlusions of the anterior circulation in the phase 2b chemical optimization of cerebral embolectomy (CHOICE) randomised trial (121 participants).”
“Adjunctive intra-arterial infusion of thrombolytic agents after successful endovascular recanalisation has the potential to further improve outcomes by lysing persisting thrombi in distal arteries and the microcirculation.”
“However, it remains uncertain whether this treatment approach could benefit patients with acute occlusions of the posterior circulation.”
“Adjunctive intra-arterial infusion of thrombolytic agents appeared promising for large vessel occlusions of the anterior circulation in the phase 2b chemical optimization of cerebral embolectomy (CHOICE) randomised trial (121 participants).”
“Adjunctive intra-arterial infusion of thrombolytic agents after successful endovascular recanalisation has the potential to further improve outcomes by lysing persisting thrombi in distal arteries and the microcirculation.”
Randomisation was central, web-based, computer-generated, with a 1:1 ratio. Blinding of outcome assessors and imaging committee is described. Sample size calculation is provided with assumptions and power. Inclusion/exclusion criteria are detailed. The analysis population (ITT) and per-protocol are defined. Outlier handling is not explicitly discussed, but missing data handling is described (no imputation needed).
“A simple randomisation process was conducted through a web based system (IRLite), accessible on mobile devices or web page platforms, utilising a central, web based, computer generated randomisation schedule.”
“all research staff conducting telephone interviews and members of the independent endpoint adjudication committee were, however, masked to the treatment assignment.”
“Based on a two sided, normal approximation test, α of 0.05, and a 1:1 randomisation, 99 patients in the treatment group and 99 in the control group would provide 80% power for comparison of the proportion of patients who achieved the primary endpoint.”
“A simple randomisation process was conducted through a web based system (IRLite), accessible on mobile devices or web page platforms, utilising a central, web based, computer generated randomisation schedule.”
“all research staff conducting telephone interviews and members of the independent endpoint adjudication committee were, however, masked to the treatment assignment.”
“Based on a two sided, normal approximation test, α of 0.05, and a 1:1 randomisation, 99 patients in the treatment group and 99 in the control group would provide 80% power for comparison of the proportion of patients who achieved the primary endpoint.”
The paper reports age, sex, and various comorbidities in Table 1. Age and sex are reported for the whole cohort and per group. Health status is captured via NIHSS and pc-ASPECTS. Demographics are adequate for a human trial.
“The mean age was 66.0 (standard deviation 11.1) years, and 24.5% (n=51) were women.”
“Mean (SD) age (years) | 65.0 (11.3) | 67.3 (10.8) | 0.17”
“The mean age was 66.0 (standard deviation 11.1) years, and 24.5% (n=51) were women.”
“Mean (SD) age (years) | 65.0 (11.3) | 67.3 (10.8)”
The paper states approval by the medical ethics committee of the First Affiliated Hospital of the University of Science and Technology of China and all relevant local ethics committees. Informed consent is mentioned in the randomisation section. Compliance with Good Clinical Practice and Declaration of Helsinki is stated.
“Approved by the medical ethics committee of the First Affiliated Hospital of the University of Science and Technology of China and all relevant local ethics committees.”
“Once written informed consent had been obtained and successful endovascular recanalisation (extended thrombolysis in cerebral infarction (eTICI) grade 2b50-3 defined as ≥50% reperfusion of the involved territory) of the target occlusion performed, patients were randomised”
“The trial was conducted in accordance to Good Clinical Practice and the Declaration of Helsinki.”
“Approved by the medical ethics committee of the First Affiliated Hospital of the University of Science and Technology of China and all relevant local ethics committees.”
“The trial was conducted in accordance to Good Clinical Practice and the Declaration of Helsinki.”
Tenecteplase is named with dose (0.0625 mg/kg, max 6.25 mg) and route. The supplier is mentioned in acknowledgments. Statistical software (STATA 17.0) is identified. No other key biological/chemical resources are used.
“Patients randomised to the tenecteplase group received an intra-arterial infusion of tenecteplase (0.0625 mg/kg, maximum dose 6.25 mg) through a distal access catheter or microcatheter located proximal to the residual thrombus (if still present) or distal to the origin of the main pontine perforator branches over 15 seconds.”
“All analyses were performed using STATA software, version 17.0.”
“Patients randomised to the tenecteplase group received an intra-arterial infusion of tenecteplase (0.0625 mg/kg, maximum dose 6.25 mg) through a distal access catheter or microcatheter”
“All analyses were performed using STATA software, version 17.0.”
Tests are named (Poisson regression with robust variance, ordinal logistic regression, linear regression). Assumptions are addressed (proportional odds verified with Brant test). Exact p-values are reported for primary outcome. Effect sizes with CIs are reported throughout. Software is identified. Data presentation includes per-group n and CIs. Mathematical plausibility checks: no obvious errors; subgroup counts sum correctly.
“A robust sandwich variance model was used to compare dichotomous outcomes: relative risk was estimated using the Poisson distribution with a log link function.”
“adjusted risk ratio 1.36, 95% confidence interval (CI) 0.92 to 2.02; P=0.12”
“mRS score 0 or 1 at day 90† | 36 (34.6) | 27 (26.0) | RR | 1.33 (0.88 to 2.03) | 1.36 (0.92 to 2.02)”
“A robust sandwich variance model was used to compare dichotomous outcomes: relative risk was estimated using the Poisson distribution with a log link function.”
“adjusted risk ratio 1.36, 95% confidence interval (CI) 0.92 to 2.02; P=0.12”
“mRS score 0 or 1 at day 90† | 36 (34.6) | 27 (26.0) | RR | 1.33 (0.88 to 2.03) | 1.36 (0.92 to 2.02)”
The data availability statement says data can be made available on reasonable request after signing data sharing agreements, but does not specify a platform, conditions, or timeframe. This is reported_but_inadequate. No code sharing is mentioned, but no bespoke code is described.
“Data collected for the study, including deidentified individual participant data and a data dictionary defining each field in the set, can be made available to researchers on reasonable request and after signing appropriate data sharing agreements.”
“Data collected for the study, including deidentified individual participant data and a data dictionary defining each field in the set, can be made available to researchers on reasonable request and after signing appropriate data sharing agreements.”
Trial registration number is provided. Methods are comprehensive. Limitations are explicitly discussed. Conclusions are proportional to the results. Funding and competing interests are declared. No reporting guideline checklist is mentioned, but the paper follows CONSORT-like structure.
“Trial registration ClinicalTrials.gov NCT05684172 (https://clinicaltrials.gov/ct2/show/NCT05684172) .”
“This study had several limitations. Firstly, as only patients from China were enrolled into the study, our results may not be generalisable to patients in western countries.”
“Funding: This study was funded by the Fundamental Research Funds for the Central Universities (YD9110002014).”
“Trial registration ClinicalTrials.gov NCT05684172 (https://clinicaltrials.gov/ct2/show/NCT05684172)”
“This study had several limitations. Firstly, as only patients from China were enrolled into the study, our results may not be generalisable to patients in western countries.”
“Funding: This study was funded by the Fundamental Research Funds for the Central Universities (YD9110002014).”
Registered (1 ID: ClinicalTrials.gov). No reporting guideline cited.
Broken references and links
None found · partly checkedReferences checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.
Nothing surfaced — but not everything feeding this category ran (missing: data/code link verification), so read this as a partial clean bill.
Checked 29 references by DOI: 28 verified — 1 no DOI (shown, not verified).
- NO DOIAdjunctive Intra-arterial Tenecteplase Following Mechanical Thrombectomy Pilot TrialNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
Copyediting
1 finding · worst lowWording, consistency and formatting errors that need correcting before submission.
- Wording or formatting errors that need correctingAssessed
6 copyedit issues flagged (1 major): mostly consistency, typo, grammar.
- MAJORconsistencyMethods, Trial design“leaving 206 patients (81%) in the per protocol analyses”→ 206 out of 208 is 99%, not 81%. Please verify the correct number or percentage.The percentage appears inconsistent with the stated number.
- MINORtypoAbstract, Results“36.4%; P=0.047”→ Remove stray semicolon or rephrase to '36.4%, P=0.047'.In the introduction, the CHOICE trial result is quoted with an extra semicolon.
- MINORconsistencyResults, Baseline characteristics“24.5% (n=51) were women”→ Ensure consistency in reporting percentages and counts; consider adding per-group breakdown.Overall percentage is given, but per-group sex counts are in Table 1.
- MINORgrammarMethods, Randomisation and masking“all research staff conducting telephone interviews and members of the independent endpoint adjudication committee were, however, masked”→ Capitalize 'All' at the start of the sentence.Sentence begins with lowercase 'all'.
- MINORtypoMethods, Randomisation and masking“all research staff conducting telephone interviews”→ Capitalize 'All' at the beginning of the sentence.Sentence starts with lowercase 'all'.
- MINORclarityDiscussion, Comparison with other studies“the proportion with a modified Rankin scale score of 0 or 1 in the ATTENTION trial was 16%, whereas in the ATTENTION-IA trial this proportion increased to 25% at 90 days.”→ Clarify which group in ATTENTION-IA is being compared (e.g., overall or control group).The comparison is ambiguous.
The published work is methodologically robust and transparent, with only minor reporting gaps. An informed reader should weigh the vague data availability statement and the minor internal inconsistencies (per-protocol percentage, absolute difference) as points that could warrant clarification or an erratum, but they do not undermine the main conclusions.
- 1.HIGHreportingCorrect the per-protocol analysis percentage in Methods, Trial design: 206 out of 208 is 99%, not 81%. Verify the correct number or percentage.This internal inconsistency is a factual error that could undermine reader trust and may warrant an erratum.
- 2.HIGHreportingClarify the comparison in the Discussion statement about mRS 0-1 proportions (ATTENTION vs ATTENTION-IA): specify which group and time point are being compared.The ambiguous comparison could mislead readers about the treatment effect.
- 3.HIGHdata codeImprove the Data availability statement to specify a concrete access mechanism (e.g., a named repository or data access committee) and conditions/timeframe for data sharing.The current 'on reasonable request' statement is vague and does not meet transparency standards for a data-driven trial.
- 4.MEDIUMreportingExplicitly state adherence to CONSORT reporting guidelines in the Methods or a separate section.Explicit guideline adherence improves transparency and is expected for RCTs.
- 5.MEDIUMrigorClarify outlier handling in the statistical analysis section, or state that no outliers were excluded.The current reporting is ambiguous and could be misinterpreted.
- 6.MEDIUMdata codeAdd a statement about the availability of statistical analysis code, even if not shared, to clarify reproducibility.Code availability is increasingly expected and clarifies reproducibility.
- 7.MEDIUMstatisticsReport exact p-values for secondary outcomes where only CIs are given, to aid interpretation.Exact p-values allow readers to assess statistical significance more precisely.
- 8.LOWcopyeditFix the stray semicolon in the Abstract Results: change '36.4%; P=0.047' to '36.4%, P=0.047'.Minor typographical error that should be corrected for clarity.
- 9.LOWcopyeditCapitalize 'All' at the start of the sentence in Methods, Randomisation and masking.Sentence begins with lowercase 'all', which is a grammatical error.
- 10.LOWreportingReconcile the reported adjusted absolute difference in the primary outcome: Results state 8.3 percentage points, Discussion states 7.6%. Clarify the discrepancy.Minor internal inconsistency that could confuse readers.
The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”
- Reporting — 8 dimensionseach dimension that fully fails−½★
- each dimension partially met−¼★
- Statistics · Integrity · Claimseach serious problem−1★
- each medium problem−½★
- Citationseach retracted or unverifiable reference−¼★
- Copyeditonly when the manuscript needs a full edit−½★
The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.
The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.
Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.
This Kaimen Rigor review is model-assisted and is not a substitute for formal expert review. It complements human evaluation by surfacing potential methodological concerns — verify each finding against the source.