Rigor Reviewed

Rigor-Reviewed Manuscript

Effect of a clinical decision support system on stroke care quality and outcomes in patients with acute ischaemic stroke (GOLDEN BRIDGE II): cluster randomised clinical trial.

Name: Αlpha¹ Rigor Record — Effect of a clinical decision support system on stroke care quality and outcomes in patients with acute ischaemic stroke (GOLDEN BRIDGE II): cluster randomised clinical trial.
Item: Effect of a clinical decision support system on stroke care quality and outcomes in patients with acute ischaemic stroke (GOLDEN BRIDGE II): cluster randomised clinical trial.
Rating: 94
Author: Αlpha¹

Zhang X, Ding L, Jing J, Wang C, Gu H, Jiang Y, Meng X, Liu T, Xie X, Xu M, Hu M, Zhang Y, Fu H, Liu P, Du C, Du K, Wang M, Li H, Gong X, Dong K, Xiong Y, Wang Y, Liu L, Zhang Z, Zang Y, Yang C, Xian Y, Peterson E, Fonarow GC, Schwamm LH, Zhao X, Wang Y, Li Z, GOLDEN BRIDGE II Investigators

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Αlpha¹ Rigor Review — 3★ (Adequate), 0 critical, 5 high issues for “Effect of a clinical decision support system on stroke care quality and outcomes in patients with acute ischaemic stroke (GOLDEN BRIDGE II): cluster randomised clinical trial.”

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Αlpha¹ Editorial

This rigor review was examined and confirmed by Αlpha¹ Editorial · August 10, 2026

Αlpha¹ Rigor Review

Rigor Reviewed

3 / 5

Adequate — real issues to address

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×4−2★

Model-reported confidence: highReviewer agreement: moderateEngine: 7.29.0Source: full text

Problems surfaced4 types

Numerical inconsistencies1

Values 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.

Internal contradictions in the reported numbersAssessed

Overstated conclusions1

Conclusions 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.

Conclusions only partially backed by the presented evidenceAssessed

Data authenticity concerns1

An 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.

Other integrity concernAssessed

Copyediting1

Wording, consistency and formatting errors that need correcting before submission.

Wording or formatting errors that need correctingAssessed

This Αlpha¹ Rigor Review uses AI 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.

The GOLDEN BRIDGE II trial is a well-designed cluster RCT with strong methodological reporting, including pre-registration, CONSORT-AI adherence, and transparent outcome reporting. Minor issues are the absence of an explicit Declaration of Helsinki compliance statement, an undefined 'absolute difference' metric that is inconsistent with percentage-point differences, and analysis code only in the supplementary appendix rather than a public repository.

The three independent reviewers converged on most dimensions (scientific premise, study design, biological variables, statistical analysis, reporting transparency). There was disagreement on ethical approvals (Reviewer 2 flagged a missing compliance statement) and data code availability (Reviewer 2 flagged inadequate code sharing, but the scoring rule allows a pass with 3 of 4 criteria adequate). The key resources dimension was rated not applicable by Reviewer 2, but the bespoke software intervention qualifies as a resource, so the pass status from the other reviewers was adopted.

10 major claims checked against the paper's own evidence: all adequately supported.

Efficacy claim is anchored to an adequate endpoint and a meaningful effect.

Recomputed 25 tests: 25 consistent, 0 inconsistent; 11 recomputed directly from the reported test statistics, 14 via agent-written checks.

4 integrity concerns flagged (0 high).

Reporting

Eight Dimensions8 pass

The paper cites previous studies like GOLDEN BRIDGE-AIS and GWTG-Stroke to support the idea that quality improvement interventions improve stroke outcomes. It also highlights the current limitations of AI applications in stroke care, specifically the lack of rigorous evaluation through randomized controlled trials, which the current study aims to address.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The study clearly establishes its premise by citing prior work on AI in healthcare and stroke quality improvement, and provides a logical rationale for the CDSS intervention.

Evidence

direct quote[Introduction, paragraph 2]

“However, the majority of AI applications for stroke healthcare have not been rigorously evaluated through randomised controlled trials.”