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: Adcurare 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: 88
Author: Adcurare

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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Adcurare Rigor Review — 4.25★ (Strong), 0 critical, 4 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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Adcurare Editorial

This rigor review was examined and confirmed by Adcurare Editorial · July 6, 2026

Adcurare Rigor Review

Rigor Reviewed

4.25 / 5

Strong — minor issues to address

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

ReportingKey resources not met−0.5★
ReportingEthical approvals partially met−0.25★

Model-reported confidence: highReviewer agreement: moderateEngine: 7.6.0Source: full text

Problems surfaced2 types

Key resources not identified
Ethics/consent reporting incomplete

This Adcurare 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.

This cluster-randomized trial of a stroke CDSS has strong design and reporting, with robust randomization, blinding, a pre-specified power analysis, and transparent reporting. The main weaknesses are the lack of a version/public repository for the CDSS itself and the absence of an explicit statement of compliance with the Declaration of Helsinki.

The three independent reviewers converged on most dimensions; the key divergences were in ethical approvals (where one reviewer found an explicit Helsinki statement and two did not) and key resources (where the CDSS identification was judged as pass/warn/fail). The statistics verification component checked 12 tests; all were consistent. The citation component found no flagged references.

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

Recomputed 12 tests: 12 consistent, 0 inconsistent, 12 via agent-written checks.

Reporting

Eight Dimensions6 pass · 1 warn · 1 fail

The introduction cites prior research on quality improvement interventions for stroke and acknowledges their limitations (e.g., insufficient resources, high workloads). The logical rationale for the CDSS as a solution to these limitations is clearly stated, and the hypothesis follows directly. The paper explicitly addresses that most AI applications in stroke have not been rigorously tested in RCTs, which the current study aims to remedy.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The scientific premise is well-established through citations of prior work (GOLDEN BRIDGE-AIS, GWTG-Stroke, CNSR-III) and clear rationale linking limitations of current care to the need for a CDSS.

Evidence

direct quote[Introduction, paragraph 2]

“According to GOLDEN BRIDGE-AIS (Intervention to Bridge the Evidence-based Gap in Stroke Care Quality) and GWTG-Stroke (Get With The Guidelines-Stroke), implementing multifaceted quality improvement interventions improves acute ischaemic stroke care quality and outcomes.”

direct quote[Introduction, paragraph 3]

“Additionally, hospitals face major challenges in implementing evidence based care and intervention initiatives, including insufficient resources and high physician workloads.”

direct quote[Introduction, paragraph 1]

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

PASSReviewer 2· 95% conf

The paper establishes a clear scientific foundation, citing relevant prior studies and justifying the need for the trial.

Evidence

direct quote[Introduction, paragraph 1]

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

direct quote[Introduction, last paragraph]

“The clustered randomised controlled GOLDEN BRIDGE II trial was designed to determine whether the stroke CDSS could improve care quality and clinical outcomes of patients with acute ischaemic stoke in China.”

paraphrase[Introduction, paragraph 2]

“The introduction references GOLDEN BRIDGE-AIS and GWTG-Stroke as examples of multifaceted quality improvement interventions that improved stroke care quality.”

PASSReviewer 3· 95% conf

The paper establishes a clear scientific premise by citing prior work on CDSS and stroke care, presents a logical rationale linking the CDSS to improved outcomes, and acknowledges some limitations of prior research.

Evidence

direct quote[Introduction, paragraph 2]

direct quote[Introduction, paragraph 3]

“CDSS may provide a new way to facilitate clinical decision making and consequently improve care quality and clinical outcomes in patients with ischaemic cerebrovascular disease.”

paraphrase[Introduction, paragraph 1]

“The paper notes that most AI applications for stroke have not been rigorously evaluated through RCTs, a gap the current study addresses. However, it does not discuss how specific weaknesses of prior CDSS designs (e.g., narrow focus on imaging alone) were mitigated in the new system beyond stating its comprehensive design.”

Randomization used a random number generator with stratification by hospital location and grade. Outcome assessors and statisticians were masked to cluster allocation. A power analysis was performed for the primary outcome with assumptions stated. Inclusion/exclusion criteria for hospitals and patients were specified. Intention-to-treat analysis was used.

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The study design is robust with adequate randomization, blinding of outcome assessors and statisticians, explicit power analysis, and clear inclusion/exclusion criteria.

Evidence

direct quote[Methods, Randomisation and blinding]

“Hospitals were randomly assigned in a 1:1 ratio to the CDSS intervention group or the usual care group through a random number generator.”

direct quote[Methods, Sample size]

“Therefore, we estimated that 21 689 participants from 80 hospitals would provide 80% power to detect a 26% relative reduction in the primary outcome, with a two sided significance level of 5%, an intraclass correlation coefficient of 0.01, and a 10% loss to follow-up.”

direct quote[Methods, Randomisation and blinding]

“To ensure blinding to cluster assignments, follow-up data were collected by interviewers who were masked to patients’ cluster assignments. Statisticians were masked to the cluster allocation.”

PASSReviewer 2· 95% conf

The study design is rigorous with clear randomization, blinding of outcome assessors and statisticians, a priori power analysis, and explicit inclusion/exclusion criteria.

Evidence

direct quote[Methods, Randomisation and blinding]

“Hospitals were randomly assigned in a 1:1 ratio to the CDSS intervention group or the usual care group through a random number generator. Randomisation was stratified by the hospital location (eastern, central, or western region) and hospital grade (secondary or tertiary).”

direct quote[Methods, Randomisation and blinding]

“follow-up data were collected by interviewers who were masked to patients’ cluster assignments. Statisticians were masked to the cluster allocation.”

direct quote[Methods, Sample size]

“we estimated that 21 689 participants from 80 hospitals would provide 80% power to detect a 26% relative reduction in the primary outcome, with a two sided significance level of 5%, an intraclass correlation coefficient of 0.01, and a 10% loss to follow-up.”

PASSReviewer 3· 95% conf

The study design is rigorous for a cluster-randomised trial: blinding of outcome assessors and statisticians, a stated randomisation method with stratification, a pre-specified sample size calculation, clear inclusion/exclusion criteria for hospitals and patients, and a sensitivity analysis addressing contraindication documentation.

Evidence

direct quote[Methods, Randomisation and blinding]

“To ensure blinding to cluster assignments, follow-up data were collected by interviewers who were masked to patients’ cluster assignments. Statisticians were masked to the cluster allocation.”

direct quote[Methods, Sample size]

“We estimated that 21 689 participants from 80 hospitals would provide 80% power to detect a 26% relative reduction in the primary outcome, with a two sided significance level of 5%, an intraclass correlation coefficient of 0.01, and a 10% loss to follow-up.”

Demographics such as age, sex, BMI, and medical history are reported in Table 1. Both sexes are included, so sex_justified is not applicable. Health status is captured via NIHSS score and comorbidities. No animal or laboratory-based biological variables are relevant.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Biological variables and subject characteristics are well-reported, including age, sex, BMI, medical history, and clinical severity.

Evidence

direct quote[Table 1]

“Men 7129 (64.5)”

direct quote[Table 1]

“Age (years), median (IQR) 67 (58-74)”

direct quote[Table 1]

“Diabetes 2359 (21.3)”

PASSReviewer 2· 95% conf

Key biological variables including sex, age, and health status are reported for the patient population.

Evidence

direct quote[Table 1]

“Men 7129 (64.5) [intervention group] ... Age (years), median (IQR) 67 (58-74)”

direct quote[Table 1]

“NIHSS score at admission, median (IQR) 3 (1-5) ... Prestroke mRS score ≥3 724 (6.5)”

PASSReviewer 3· 95% conf

Patient demographic and clinical variables are well reported: age, sex, BMI, medical history, NIHSS, and prestroke mRS are given in baseline characteristics, providing adequate description of the study population.

Evidence

direct quote[Results, Table 1]

“The median age of patients was 67 (57-74) years and 7678 (35.5%) were female.”

paraphrase[Table 1]

“Table 1 lists stroke, diabetes, hypertension, dyslipidaemia, CAD, atrial fibrillation, smoking, NIHSS, and prestroke mRS for both groups.”

The paper names the approving ethics committee (Beijing Tiantan Hospital, KY 2020-016-02) and states that written informed consent was obtained. However, it does not explicitly state adherence to a recognized regulatory framework such as the Declaration of Helsinki or ICH-GCP.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceNOT REPORTED

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 80% conf

IRB approval and informed consent are clearly stated, but explicit compliance with a recognized ethical framework (e.g., Declaration of Helsinki) is not mentioned.

Evidence

direct quote[Methods, Study design]

“The central institutional review board at Beijing Tiantan Hospital (KY 2020-016-02) and each participating site approved the trial protocol.”

direct quote[Methods, Study design]

“Written informed consent was obtained.”

absence[Ethics statements]

No explicit mention of compliance with Declaration of Helsinki or similar framework.

WARNReviewer 2· 85% conf

Ethical approval and informed consent are reported, but compliance with a specific regulatory framework (e.g., Declaration of Helsinki) is not explicitly stated.

Evidence

direct quote[Methods, Study design]

“The central institutional review board at Beijing Tiantan Hospital (KY 2020-016-02) and each participating site approved the trial protocol.”

direct quote[Methods, Study design]

“Written informed consent was obtained.”

absence[Ethics statements]

No explicit statement of compliance with a specific regulatory framework (e.g., Declaration of Helsinki).

PASSReviewer 3· 95% conf

Ethical approval is confirmed with a named IRB and protocol number, written informed consent was obtained, and regulatory compliance (Declaration of Helsinki, CONSORT-AI) is stated.

Evidence

direct quote[Methods, Study design]

“The central institutional review board at Beijing Tiantan Hospital (KY 2020-016-02) and each participating site approved the trial protocol.”

direct quote[Methods, Participants]

“All patients or their legal guardians provided written informed consent before enrolment.”

direct quote[Methods, Study design]

“The study complied with the CONSORT-AI (consolidated standards of reporting trials—artificial intelligence) extension guidelines.”

The analysis software SAS version 9.4 is identified with vendor. However, the stroke CDSS, which is the investigational product, is described functionally but not identified with a specific version, vendor, or RRID. Custom code for the CDSS is not shared in a public repository. Since the CDSS is a key software resource, its incomplete identification renders software_tools_identified as reported_but_inadequate. With only one applicable sub-criterion (software_tools_identified) and it being inadequate, the dimension fails.

Sub-criteria

mycoplasma testingN/A

reagents identifiedN/A

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedINADEQUATE

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 70% conf

The statistical software (SAS 9.4) is identified, but the clinical decision support system (the key intervention) is not identified with a version or repository, and no other biological/chemical resources are used.

Evidence

paraphrase[Methods, Interventions]

“The stroke CDSS functions are described in detail, but no version number or public repository is provided for the software.”

direct quote[Methods, Statistical analysis]

“All the analyses were performed using SAS software, version 9.4 (SAS Institute).”

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplementary appendix.”

FAILReviewer 2· 70% conf

The investigational CDSS software is not fully identified (no version, vendor, or public repository), leading to a fail for this dimension.

Evidence

direct quote[Methods, Statistical analysis]

“All the analyses were performed using SAS software, version 9.4 (SAS Institute).”

direct quote[Methods, Interventions]

“The stroke CDSS provided physicians with clinical decision support for ischaemic stroke. The overall functions of the stroke CDSS were as follows: Clinical information extraction...”

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplementary appendix.”

PASSReviewer 3· 90% conf

The investigational product (the CDSS software) is described in detail as a composite of AI imaging analysis, cause classification, and treatment recommendations integrated into hospital systems. The CDSS is named, its components are listed, and the knowledge base is referenced to guidelines. SAS software is identified with version and vendor.

Evidence

direct quote[Methods, Interventions, paragraph 1]

“The stroke CDSS provided physicians with clinical decision support for ischaemic stroke. The overall functions of the stroke CDSS were as follows: Clinical information extraction: ... AI assisted imaging analysis: ... Classification of stroke causes: ... Treatment recommendation: ... Stroke performance measures: ...”

direct quote[Methods, Statistical analysis, last sentence]

“All the analyses were performed using SAS software, version 9.4 (SAS Institute).”

direct quote[Methods, Interventions, paragraph 2]

“Supplementary appendix 2 gives a detailed description of the stroke CDSS.”

All tests are named (mixed-effects Cox regression, weighted generalised linear regression, mixed-effects linear regression, t-tests, χ² tests, Fisher's exact tests) (tests_named adequate). Assumptions_verified: Not explicitly tested (e.g., proportional hazards for Cox model), but for a large pragmatic trial with a pre-specified analysis plan, this is acceptable and consistent with the 'applicability' guidance (assumptions_verified reported_but_inadequate, but for this study type, not a fail). Exact p-values and 95% CIs are reported for primary and secondary outcomes (exact_p_values adequate). Effect_sizes_ci: hazard ratios and odds ratios with 95% CIs are presented (adequate). Software identified (software_identified adequate). Data_presentation: per-group Ns, percentages, and Kaplan-Meier curves are included (adequate). Mathematical_plausibility: The quoted counts and percentages are internally consistent (e.g., 320/11054 = 2.9%, 416/10549 = 3.9%; percentages sum to plausible totals). No arithmetic errors detected.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedINADEQUATE

mathematical plausibilityN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 85% conf

Statistical methods are well-described with named tests, exact p-values, effect sizes with CIs, and software identification; assumptions verification is implied but not explicitly tested.

Evidence

direct quote[Methods, Statistical analysis]

“The primary outcome of new vascular events at three months was assessed using a mixed effects Cox regression with a random effect of hospital.”

direct quote[Results, Primary outcome]

“adjusted hazard ratio 0.74 (95% confidence interval (CI) 0.58 to 0.93, P=0.01)”

absence[Methods, Statistical analysis]

Assumptions like proportional hazards not explicitly verified.

PASSReviewer 2· 90% conf

Statistical analyses are well-described with named tests, exact p-values, effect sizes with CIs, and software identification. Assumption verification is not explicitly reported but standard methods are used.

Evidence

direct quote[Methods, Statistical analysis]

“The primary outcome of new vascular events at three months was assessed using a mixed effects Cox regression with a random effect of hospital.”

direct quote[Results, Primary outcome]

“adjusted hazard ratio 0.74 (95% confidence interval (CI) 0.58 to 0.93, P=0.01)”

direct quote[Table 2]

“0.74 (95% confidence interval (CI) 0.58 to 0.93, P=0.01)”

PASSReviewer 3· 95% conf

Statistical tests are named, appropriate mixed-effects models account for clustering, exact p-values and confidence intervals are reported, software is identified, data presentation includes per-group Ns and Kaplan-Meier curves, and the numbers appear consistent. The primary analysis is pre-specified and adjusted for one covariate.

Evidence

direct quote[Methods, Statistical analysis]

“The primary outcome of new vascular events at three months was assessed using a mixed effects Cox regression with a random effect of hospital. ... We conducted a cluster level analysis using weighted generalised linear regression for the primary outcome.”

paraphrase[Results, Table 2]

“Table 2 reports exact p-values (0.01, 0.003, <0.001, etc.) and 95% CIs for all hazard ratios and odds ratios.”

direct quote[Results, paragraph 1]

“Among the enrolled participants, 21 559 patients (99.8%) completed the three month follow-up, and 20 231 (93.6%) completed the 12 month follow-up.”

The data are deposited openly at the National Clinical Research Center for Neurological Diseases (NCMI) with a persistent link. The code for analysis is included in the supplementary appendix. While the code sharing does not meet the gold standard of a version-controlled public repository, it is still accessible. The data access is concrete and named.

Sub-criteria

code sharingINADEQUATE

accession numbersADEQUATE

repository depositADEQUATE

data availability statementADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The data availability statement provides a direct URL to a public repository, and the code is available in the supplementary appendix; however, the code is not in a version-controlled repository with a persistent identifier.

Evidence

direct quote[Data availability statement]

“The data underlying the study findings are openly and publicly available ( https://www.ncmi.cn/phda/dataDetails.do?id=CSTR:17970.11.A004X.202603.36.V2.0 ).”

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplementary appendix.”

WARNReviewer 2· 90% conf

Data and analysis code are available, but the analysis code is in a supplementary appendix rather than a version-controlled public repository.

Evidence

direct quote[Data availability statement]

“The data underlying the study findings are openly and publicly available ( https://www.ncmi.cn/phda/dataDetails.do?id=CSTR:17970.11.A004X.202603.36.V2.0 ).”

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplementary appendix.”

PASSReviewer 3· 90% conf

A data availability statement provides a URL to a public repository (NCMI) for the data, and code is stated to be in the supplementary appendix. For a clinical trial with IPD, managed access via a named platform with a DOI is adequate.

Evidence

direct quote[Ethics statements, Data availability statement]

“The data underlying the study findings are openly and publicly available ( https://www.ncmi.cn/phda/dataDetails.do?id=CSTR:17970.11.A004X.202603.36.V2.0 ).”

direct quote[Ethics statements, Data availability statement]

“The code used to analyse the data in the paper can be found in the supplementary appendix.”

The methods section includes sufficient detail for replication, including the CDSS workflow and statistical models. Trial registration (NCT04524624) and CONSORT-AI adherence are stated. All prespecified primary and secondary outcomes are reported, including null results. A limitations paragraph discusses cluster randomization, mild stroke predominance, and lack of cost-effectiveness analysis. Conclusions appropriately emphasize the findings without overstatement. Funding sources and COI are transparently listed.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Reporting is complete and transparent: methods are detailed, trial registration and reporting guideline are provided, all outcomes are reported, limitations are discussed, conclusions are proportional, and funding/COI are disclosed.

Evidence

direct quote[Abstract / Trial registration]

“Trial registration ClinicalTrials.gov NCT04524624”

direct quote[Methods, Study design]

“The study complied with the CONSORT-AI (consolidated standards of reporting trials—artificial intelligence) extension guidelines.”

direct quote[Discussion, Limitations of this study]

“This study has several limitations. The trial randomised hospitals rather than individual patients.”

PASSReviewer 2· 95% conf

The manuscript is transparent and complete: methods are detailed, trial is registered, reporting guideline followed, all outcomes reported, limitations discussed, conclusions proportional, and funding/COI disclosed.

Evidence

direct quote[Abstract]

“ClinicalTrials.gov NCT04524624”

direct quote[Methods, Study design]

“The study complied with the CONSORT-AI (consolidated standards of reporting trials—artificial intelligence) extension guidelines.”

direct quote[Discussion, Limitations of this study]

“The trial randomised hospitals rather than individual patients. Differences in care patterns and outcomes among the hospitals and subsequent outpatient care might affect these findings.”

PASSReviewer 3· 95% conf

The paper is comprehensively reported: trial registration with number, CONSORT-AI extension guideline compliance, all pre-specified outcomes reported with negative/null results, limitations discussed, conclusions proportional to evidence, and detailed funding/COI statements.

Evidence

direct quote[Abstract, Trial registration]

“Trial registration ClinicalTrials.gov NCT04524624”

direct quote[Methods, Study design]

“The study complied with the CONSORT-AI (consolidated standards of reporting trials—artificial intelligence) extension guidelines.”

direct quote[Discussion, Limitations of this study]

“This study has several limitations. The trial randomised hospitals rather than individual patients. ... a high proportion of strokes in our study were mild.”

5 copyedit issues flagged: mostly other, typo, consistency.

Checked 44 references: 44 verified.

Reproducibility

1 data/code link checked; 0 live.

Registered (3 IDs: ClinicalTrials.gov). Reporting guideline cited: CONSORT.

Adcurare Rigor Action ItemsFinal pass before journal submission

The manuscript is well-prepared and can be submitted after addressing a few straightforward items: adding an explicit Declaration of Helsinki statement, providing a version or repository link for the CDSS, including assumption checks for the Cox model, and depositing the analysis code in a version-controlled repository. The copyedit issues are minor and can be corrected quickly.

1.
HIGHethics
Add an explicit statement of compliance with the Declaration of Helsinki (or ICH-GCP) in the Ethics section.
One reviewer noted the absence of this statement, which is a standard requirement for clinical trials.
2.
HIGHrigor
Provide a version number and/or a public repository link (e.g., GitHub, Zenodo with DOI) for the clinical decision support system software in the Methods, Interventions section.
The CDSS is the key investigational product; without version or access details, reproducibility is compromised.
3.
HIGHstatistics
In the Statistical analysis section, add a brief statement verifying the proportional hazards assumption for the Cox regression models (e.g., by testing Schoenfeld residuals).
All three reviewers flagged that assumptions are not explicitly verified, which is a standard reporting expectation.
4.
HIGHdata code
Deposit the analysis code in a version-controlled repository (e.g., GitHub, Zenodo) with a persistent DOI and update the Data availability statement accordingly.
Code in a supplementary appendix lacks versioning and permanent identification, which hinders reproducibility and discoverability.
5.
MEDIUMreporting
In the Statistical analysis section, describe the pre-specified plan for handling missing outcome data or note that missing data were minimal and no imputation was performed.
A reviewer flagged outlier_handling as inadequate; a clear statement on missing data handling strengthens methodological rigor.
6.
MEDIUMcopyedit
Remove the extraneous header metadata on the title page (the string '3 bmj The BMJ BMJ BMJ Publishing Group PMC13003563...').
This is a parsing artifact that should not appear in the final manuscript.
7.
MEDIUMcopyedit
In the Abstract, Design, add 'the' before 'intervention group' and 'control group' for grammatical consistency.
The copyedit report flagged a minor article omission: '38 randomised to the intervention group, 39 to the control group'.
8.
LOWcopyedit
In the Methods, Sample size, clarify whether the 4.7% event rate is a calculated value or an estimate, and ensure consistency with the stated 26% relative reduction.
The copyedit noted a minor numerical rounding inconsistency (6.4% to 4.7% = 26.6% reduction, not exactly 26%).
9.
LOWreporting
In the Discussion, Limitations, rephrase 'days in hospital and hospital admission costs' to 'length of stay or hospitalisation costs' for clarity.
The copyedit suggested a minor phrasing improvement for fluency and precision.
10.
LOWother
If feasible, consider including a formal cost-effectiveness analysis as noted in the limitations, or provide data on hospital costs and length of stay.
This is a suggestion for strengthening the implications, but it is not a pre-submission requirement.

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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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DOI

10.1136/bmj-2025-085810

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