Prophylactic tranexamic acid for the prevention of postpartum haemorrhage in women with placenta praevia: multicentre, double blind, randomised, placebo controlled, phase 3 trial.
Zhang L, Bi S, Chen L, Du L, He F, Qiao Y, Li Z, Zeng W, Zhao X, Chen X, Li X, Ding G, Zhou W, Sun B, Guo Q, Guo X, Jin F, Wang X, Zhu Q, Sun Q, Jiang S, Wang X, Cai F, Jiang Y, Gao J, Wang Z, Wang Z, Zhang L, Liu JM, Huang L, Yu L, Chen J, Zhang S, Poon LC, Li HT, Chen D, study’s collaborator group
- DOI
- 10.1136/bmj-2026-089636
- Record issued
- 2026-08-15
- Engine
- 7.39.0
- Exported
- 2026-09-22
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/f58e1887-70b3-428d-9951-e452d4592fce is authoritative.
How this rating was calculated
- IntegrityIntegrity concern ×2−1★
- ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
- ClaimsTreatment effect not shown to be clinically meaningful−0.5★
- CitationsUnresolved reference−0.25★
- The numeric-impossibility checks (GRIM/GRIMMER/DEBIT/SPRITE) did not run: 4 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.
- 01Efficacy rests on an unvalidated surrogate endpoint
The primary outcome is postpartum haemorrhage, defined as calculated estimated blood loss ≥1000 mL or red cell transfusion within two days after delivery. This is a surrogate/clinical proxy for severe maternal morbidity, not a hard clinical outcome like mortality. The paper does not demonstrate target engagement at the tested dose (e.g., PK/PD) nor cite validated evidence linking this surrogate to a hard clinical outcome. The reduction in this surrogate is presented as the efficacy claim.
“The primary outcome was postpartum haemorrhage, defined as calculated estimated blood loss ≥1000 mL or as red cell transfusion within two days after delivery.”
- 02Treatment effect not shown to be clinically meaningful
The primary outcome occurred in 29.7% of the tranexamic acid group versus 35.1% in the placebo group, a relative risk of 0.85 (95% CI 0.75 to 0.96). The absolute risk reduction is 5.4 percentage points, and the number needed to treat is 19. The authors themselves describe the reduction as 'modest' and do not anchor it to a minimal clinically important difference or demonstrate that this magnitude is clinically meaningful.
“treatment with tranexamic acid resulted in a statistically significant yet modest reduction in the incidence of postpartum haemorrhage”
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, rigorously reported randomised controlled trial. The methods are thorough, ethical approvals are documented, and data/code are openly available. Minor reporting gaps include lack of explicit CONSORT adherence and some inconsistencies in denominators across outcomes.
Both reviewers agreed on all dimensions and study type. The statistics verification covered only a subset of tests (3 tests with test statistics or effect estimates); other tests were not machine-verified. The citation check flagged one reference not found in registry, which is a potential fabrication signal.
Numerical inconsistencies
1 finding · worst lowValues 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
Recomputed 3 tests: 3 consistent, 0 inconsistent; 3 via agent-written checks.
- CONSISTENTreported p = .010 · recomputed p = .010Reviewers 1, 2Primary outcome relative risk p-value from reported RR and 95.2% CI
“Postpartum haemorrhage occurred in 251 of 845 participants (29.7%) in the tranexamic acid group and 297 of 846 (35.1%) in the placebo group (relative risk 0.85, 95.2% CI 0.75 to 0.96; P=0.01).”
Taken as given: The relative risk is 0.85.; The 95.2% confidence interval is 0.75 to 0.96.; The CI is for a ratio (log scale).Method: Used pCI function with log=1 for ratio.How we recomputed it: pCI(0.85, 0.75, 0.96, 1) - CONSISTENTreported p = .990 · recomputed p = .989Reviewer 1Serious adverse events relative risk p-value from reported RR and 95% CI
“The rates of serious adverse events were similar between the tranexamic acid group and placebo group (0.5% (4 of 837) v 0.5% (4 of 845); relative risk 1.01, 95% CI 0.25 to 4.00).”
Taken as given: The relative risk is 1.01.; The 95% confidence interval is 0.25 to 4.00.; The CI is for a ratio (log scale).Method: Used pCI function with log=1 for ratio.How we recomputed it: pCI(1.01, 0.25, 4.00, 1) - CONSISTENTreported p = .100 · recomputed p = .130Reviewer 2Red cell transfusion relative risk p-value from reported RR and 95% CI
“The red cell transfusion rate within two days after delivery was 18.8% (159 of 845) in the tranexamic acid group versus 21.6% (183 of 849) in the placebo group (relative risk 0.88, 95% CI 0.74 to 1.03).”
Taken as given: The reported RR is 0.88 and the 95% CI is 0.74 to 1.03.; The CI is two-sided and the p-value is two-tailed.; The p-value is derived from the same model that produced the RR and CI.Method: Recomputed two-tailed p-value from the reported RR and CI using the pCI function with log=1 for a ratio.How we recomputed it: pCI(0.88, 0.74, 1.03, 1)
- lowinternal contradictionThe abstract reports primary outcome data for 99.8% (1691/1694) of remaining women, but the results section reports 845 in tranexamic acid and 846 in placebo for the primary outcome, summing to 1691. This is consistent.
“Primary outcome data were available for 99.8% (1691/1694) of the remaining women.”
AbstractFind in source - lowinternal contradictionThe placebo group size varies between 846 and 849 across different outcomes, which may be due to missing data but is not consistently explained.
Postpartum haemorrhage occurred in 251 of 845 participants (29.7%) in the tranexamic acid group and 297 of 846 (35.1%) in the placebo group... The red cell transfusion rate within two days after delivery was 18.8% (159 of 845) in the tranexamic acid group versus 21.6% (183 of 849) in the placebo group.
Table 2reviewer’s wording
Overstated conclusions
3 findings · 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.
- Efficacy rests on an unvalidated surrogate endpointAssessed
- Treatment effect not shown to be clinically meaningfulAssessed
- Conclusions only partially backed by the presented evidenceAssessed
6 major claims checked against the paper's own evidence: 1 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.
- partialReviewer 1Tranexamic acid may have greater clinical utility in high-risk patients than in low-risk populations.The NNTs are lower than those in previous trials, but this is an indirect comparison and not directly tested.Evidence: NNTs of 19, 17, and 37 compared to previous trials.
“These values are lower than those reported in two previous trials involving low risk or mixed risk populations (∼50% unscheduled caesarean delivery), suggesting that tranexamic acid may have greater clinical utility in patients at high risk of postpartum haemorrhage.”
DiscussionFind in source - supportedReviewers 1, 2Prophylactic tranexamic acid reduces the incidence of postpartum haemorrhage in women with placenta praevia undergoing caesarean delivery.The primary outcome showed a statistically significant reduction (RR 0.85, 95% CI 0.75-0.96, P=0.01), supporting the claim.Evidence: Primary outcome result: 29.7% vs 35.1%, RR 0.85, 95% CI 0.75-0.96, P=0.01.
“The primary outcome occurred in 29.7% (251/845) of the tranexamic acid group and 35.1% (297/846) of the placebo group (relative risk 0.85, 95.2% confidence interval (CI) 0.75 to 0.96; P=0.01).”
AbstractFind in source - supportedReviewer 1Tranexamic acid does not increase serious adverse events.Serious adverse event rates were similar between groups (0.5% vs 0.5%), with a wide CI, supporting the claim of no signal of increased risk.Evidence: Serious adverse events: 4/837 vs 4/845, RR 1.01, 95% CI 0.25-4.00.
“The rates of serious adverse events were similar between the tranexamic acid group and placebo group (0.5% (4 of 837) v 0.5% (4 of 845); relative risk 1.01, 95% CI 0.25 to 4.00).”
AbstractFind in source - supportedReviewers 1, 2The reduction in postpartum haemorrhage is modest.The absolute risk reduction is 5.4 percentage points, and the NNT is 19, which is consistent with a modest effect.Evidence: NNT of 19 for postpartum haemorrhage.
The number needed to treat to prevent one event was 19 for postpartum haemorrhage.
Discussionreviewer’s wording - supportedReviewer 2No signal of increased serious adverse events with tranexamic acid.The rates of serious adverse events were identical (0.5% in both groups), and the relative risk was 1.01 with a wide CI, supporting no signal of harm.Evidence: Serious adverse events: 0.5% (4/837) vs 0.5% (4/845), RR 1.01, 95% CI 0.25-4.00.
“The rates of serious adverse events were similar between the tranexamic acid group and placebo group (0.5% (4 of 837) v 0.5% (4 of 845); relative risk 1.01, 95% CI 0.25 to 4.00).”
AbstractFind in source - supportedReviewer 2The trial addresses a critical gap in evidence for high-risk populations.The paper focuses on women with placenta praevia, a high-risk group, and provides new evidence for this population.Evidence: The trial enrolled women with placenta praevia, a high-risk group, and the introduction highlights the lack of prior evidence.
“Such selective enrolment has left a critical gap in prophylactic use of tranexamic acid in high risk patients, who have a considerably high risk of haemorrhage and may derive greater clinical benefit from preventive interventions.”
IntroductionFind in source
Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.
- INADEQUATESurrogate endpointThe primary outcome is postpartum haemorrhage, defined as calculated estimated blood loss ≥1000 mL or red cell transfusion within two days after delivery. This is a surrogate/clinical proxy for severe maternal morbidity, not a hard clinical outcome like mortality. The paper does not demonstrate target engagement at the tested dose (e.g., PK/PD) nor cite validated evidence linking this surrogate to a hard clinical outcome. The reduction in this surrogate is presented as the efficacy claim.
“The primary outcome was postpartum haemorrhage, defined as calculated estimated blood loss ≥1000 mL or as red cell transfusion within two days after delivery.”
- INADEQUATEEffect sizeThe primary outcome occurred in 29.7% of the tranexamic acid group versus 35.1% in the placebo group, a relative risk of 0.85 (95% CI 0.75 to 0.96). The absolute risk reduction is 5.4 percentage points, and the number needed to treat is 19. The authors themselves describe the reduction as 'modest' and do not anchor it to a minimal clinically important difference or demonstrate that this magnitude is clinically meaningful.
“treatment with tranexamic acid resulted in a statistically significant yet modest reduction in the incidence of postpartum haemorrhage”
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
None foundRequired detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.
Checked — nothing surfaced.
The introduction cites prior work on tranexamic acid for postpartum haemorrhage, acknowledges limitations of previous studies (low-risk or mixed-risk populations), and provides a logical rationale for the trial. The hypothesis follows directly from the cited evidence.
“Tranexamic acid, an antifibrinolytic agent that inhibits plasmin mediated fibrinolysis, has been shown to effectively reduce the incidence of postpartum haemorrhage during caesarean delivery in low risk populations.”
“Therefore, we conducted a randomised, double blind, placebo controlled trial to investigate whether tranexamic acid could reduce the incidence of postpartum haemorrhage without increasing the risk of adverse events in women with placenta praevia undergoing caesarean delivery.”
“Tranexamic acid, an antifibrinolytic agent that inhibits plasmin mediated fibrinolysis, has been shown to effectively reduce the incidence of postpartum haemorrhage during caesarean delivery in low risk populations.”
“Notably, previous studies have predominantly enrolled participants from low risk or mixed risk (∼50% unscheduled caesarean delivery) populations. Such selective enrolment has left a critical gap in prophylactic use of tranexamic acid in high risk patients, who have a considerably high risk of haemorrhage and may derive greater clinical benefit from preventive interventions.”
“Therefore, we conducted a randomised, double blind, placebo controlled trial to investigate whether tranexamic acid could reduce the incidence of postpartum haemorrhage without increasing the risk of adverse events in women with placenta praevia undergoing caesarean delivery.”
Randomization used a centralized computer-generated method with block size six and stratification. Blinding was comprehensive (participants, investigators, clinical staff, sponsor, data analysts). Sample size calculation was based on a systematic review and accounted for attrition. Inclusion/exclusion criteria were pre-specified. The analysis populations (ITT, safety, per-protocol) were defined. Outlier handling is addressed through missing data exclusion and sensitivity analyses.
“Study investigators randomly assigned patients in a 1:1 ratio using a centralised computer generated randomisation (Sun Yat-sen University Cancer Centre, Guangzhou, China) with a block size of six to receive either tranexamic acid or placebo.”
“Participants, investigators, clinical staff, the study sponsor, and the data analysts were masked to treatment assignment.”
“To achieve 80% power in detecting a ≥20% relative difference in incidence (33% in the placebo group versus 26.4% in the tranexamic acid group) at a two sided type I error rate of 5%, the required sample size was determined to be 1500 (750 in each group) based on a standard two sample test for comparing proportions.”
“Study investigators randomly assigned patients in a 1:1 ratio using a centralised computer generated randomisation (Sun Yat-sen University Cancer Centre, Guangzhou, China) with a block size of six to receive either tranexamic acid or placebo.”
“Participants, investigators, clinical staff, the study sponsor, and the data analysts were masked to treatment assignment.”
“To achieve 80% power in detecting a ≥20% relative difference in incidence (33% in the placebo group versus 26.4% in the tranexamic acid group) at a two sided type I error rate of 5%, the required sample size was determined to be 1500 (750 in each group) based on a standard two sample test for comparing proportions.”
The paper reports age, BMI, education, mode of conception, parity, gestational age, and other relevant characteristics in Table 1. Sex is inherently female (pregnant women), so sex_justified is not applicable. Species/strain and housing conditions are not applicable for a human trial.
“Mean (SD) age (years) | 33.8 (4.3) | 34.0 (4.4)”
“Mean (SD) age (years) | 33.8 (4.3) | 34.0 (4.4)”
The trial was approved by the Clinical Research and Applied Ethics Committee of The Third Affiliated Hospital, Guangzhou Medical University (ethics review No 045). Written informed consent was obtained from all participants or legally authorised representatives. Compliance with ethical standards is implied.
“The trial was approved the Clinical Research and Applied Ethics Committee of The Third Affiliated Hospital, Guangzhou Medical University on 30 May 2023 (ethics review No 045).”
“All patients or their legally authorised representatives (ie, spouse or parents) provided written informed consent before randomisation.”
“The trial was approved the Clinical Research and Applied Ethics Committee of The Third Affiliated Hospital, Guangzhou Medical University on 30 May 2023 (ethics review No 045).”
“All patients or their legally authorised representatives (ie, spouse or parents) provided written informed consent before randomisation.”
Tranexamic acid (Chengdu Lier Pharmaceutical) and placebo (Hebei Tiancheng Pharmaceutical) are named with formulation and dose. R version 4.4.3 is identified. No antibodies, cell lines, or other biological resources are used.
“The information on randomisation was sent to the pharmacy department of The Third Affiliated Hospital, Guangzhou Medical University, which prepared and distributed the tranexamic acid (Chengdu Lier Pharmaceutical, Dujiangyan, Sichuan, China) and placebo (Hebei Tiancheng Pharmaceutical, Cangzhou, Hebei, China).”
“All statistical analyses were performed using R version 4.4.3.”
“The information on randomisation was sent to the pharmacy department of The Third Affiliated Hospital, Guangzhou Medical University, which prepared and distributed the tranexamic acid (Chengdu Lier Pharmaceutical, Dujiangyan, Sichuan, China) and placebo (Hebei Tiancheng Pharmaceutical, Cangzhou, Hebei, China).”
“All statistical analyses were performed using R version 4.4.3.”
The primary analysis used log-binomial mixed effects regression with a prespecified threshold (P<0.048). Effect sizes (relative risks) with 95% CIs are reported. Software is identified. Data presentation includes per-group n and appropriate measures. Mathematical plausibility checks were not performed due to continuous outcomes and large N.
“For binary outcomes, we used log-binomial mixed effects regression models with study centre as a random effect, adjusting for maternal age group and placenta praevia type, to estimate relative risks with 95% confidence intervals (CIs) for the tranexamic acid group versus placebo group.”
“For binary outcomes, we used log-binomial mixed effects regression models with study centre as a random effect, adjusting for maternal age group and placenta praevia type, to estimate relative risks with 95% confidence intervals (CIs) for the tranexamic acid group versus placebo group.”
“The incidence of calculated estimated blood loss ≥1000 mL was 25.7% (217 of 845) in the tranexamic acid group versus 31.6% (267 of 846) in the placebo group (relative risk 0.81, 95% CI 0.70 to 0.93).”
The data availability statement indicates data are openly available at a GitHub repository, and code is in the supplementary file. This provides a concrete access route.
“The data underlying the findings in this paper are openly and publicly available and can be found at https://github.com/ChenDunjin-GZHMU .”
“The code used to analyse the data in the paper are in the supplementary file.”
“The data underlying the findings in this paper are openly and publicly available and can be found at https://github.com/ChenDunjin-GZHMU .”
“The code used to analyse the data in the paper are in the supplementary file.”
Trial registration number is provided (NCT05811676). Methods are comprehensive. Limitations are explicitly discussed. Conclusions are proportional. Funding sources and competing interests are declared.
“Trial registration ClinicalTrials.gov NCT05811676 .”
“The main limitation of this study was that, despite intending to systematically record all ineligible women and reasons for exclusion, comprehensive data collection was not feasible owing to practical constraints during the trial.”
“Trial registration ClinicalTrials.gov NCT05811676 .”
“The main limitation of this study was that, despite intending to systematically record all ineligible women and reasons for exclusion, comprehensive data collection was not feasible owing to practical constraints during the trial.”
Registered (1 ID: ClinicalTrials.gov). No reporting guideline cited.
Broken references and links
1 finding · worst lowReferences 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.
- References not resolvable to a published paperRecomputed
Checked 26 references by DOI: 24 verified — 1 DOI unresolved, 1 no DOI (shown, not verified).
- UNRESOLVED10.3760/cma.j.issn.0529-567x.2020.01.002[Guidelines for the diagnosis and management of placenta previa (2020)]Cited DOI does not resolve to any Crossref record.
- NO DOIA Roadmap to combat postpartum haemorrhage between 2023 and 2030No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
1 data/code link checked; 1 live.
- codeGitHubLIVEHTTP 200https://github.com/ChenDunjin-GZHMUResolves to GitHub (code repository).
Copyediting
5 minorWording, consistency and formatting errors that need correcting before submission.
No major wording or formatting errors. 5 minor suggestions below.
5 copyedit issues flagged: mostly consistency, clarity, typo.
- MINORtypoAbstract, Results“0.5% (4 of 837) v 0.5% (4 of 845)”→ Use 'vs' instead of 'v' for consistency.Minor formatting inconsistency.
- MINORconsistencyResults, Primary outcome“297 of 846 (35.1%)”→ Ensure denominator is consistent with Table 2 (846 vs 849).The denominator for the placebo group primary outcome is 846, but the total placebo group is 849; this is explained by missing data.
- MINORclarityMethods, Statistical analysis“When these models failed to converge, we estimated adjusted relative risks using a modified Poisson regression model with generalised estimating equations”→ Clarify how often models failed to converge.Could be useful for transparency.
- MINORconsistencyResults, Primary outcome“297 of 846 (35.1%)”→ Ensure consistent denominator for placebo group (846 vs 849) across outcomes.The placebo group size varies between 846 and 849 in different outcomes; clarify the analysis population.
- MINORclarityMethods, Statistical analysis“When these models failed to converge, we estimated adjusted relative risks using a modified Poisson regression model with generalised estimating equations”→ Clarify the exact conditions for model non-convergence and the decision rule.Could be more explicit about the criteria for switching models.
The published work is robust and generally trustworthy. An informed reader should weigh the minor reporting gaps (e.g., explicit CONSORT adherence, denominator inconsistencies) and the one unresolved reference. No erratum is warranted for the main findings, but the authors should consider issuing a correction for the reference and clarifying the denominator inconsistencies.
- 1.HIGHreportingVerify and correct the reference '[Guidelines for the diagnosis and management of placenta previa (2020)]' (DOI 10.3760/cma.j.issn.0529-567x.2020.01.002) which was not found in any registry; replace with a verifiable source or confirm its existence.An unresolved reference is a potential fabrication signal that must be addressed.
- 2.HIGHreportingAdd an explicit statement of adherence to CONSORT reporting guidelines in the Methods or a separate section, and mention the checklist is available as supplementary material.Explicit reporting guideline adherence enhances transparency and reproducibility.
- 3.MEDIUMreportingClarify the denominator inconsistencies for the placebo group (846 vs 849) across outcomes in the Results and Table 2, explaining the analysis population for each outcome.Inconsistent denominators may confuse readers and undermine confidence in the reported results.
- 4.MEDIUMreportingClarify the criteria and frequency for switching from log-binomial to modified Poisson regression when models fail to converge in the Methods, Statistical analysis section.Transparency about model convergence decisions is important for reproducibility.
- 5.MEDIUMreportingProvide a CONSORT flow diagram in the main text or supplementary materials showing participant flow from screening to analysis.A flow diagram improves transparency of participant disposition and missing data.
- 6.MEDIUMdata codeProvide a versioned DOI for the GitHub repository and code to ensure long-term access and reproducibility.A DOI provides a permanent, citable link to the data and code.
- 7.MEDIUMstatisticsReport the intraclass correlation coefficient (ICC) for the primary outcome to quantify centre heterogeneity.ICC provides insight into the clustering effect and the appropriateness of the mixed model.
- 8.MEDIUMstatisticsAdd a sensitivity analysis using multiple imputation for missing data to assess robustness of the primary outcome.Sensitivity analyses strengthen the validity of the findings in the presence of missing data.
- 9.LOWcopyeditReplace 'v' with 'vs' in the Abstract Results section for consistency.Minor formatting inconsistency.
- 10.LOWreportingDescribe the role of the data monitoring committee and any interim analyses in the Methods.Transparency about oversight and interim analyses is expected for phase 3 trials.
- 11.LOWreportingProvide the full statistical analysis plan as a supplementary file.Full SAP enhances reproducibility and transparency.
- 12.LOWreportingDiscuss the generalizability of findings to other populations with different BMI distributions or healthcare settings.Single-country trial may limit generalizability; explicit discussion helps readers interpret.
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.