Agreement Between Large Language Models, Human Reviewers, and Authors in Evaluating STROBE Checklists for Observational Studies in Rheumatology

TL;DR

This study compares the agreement of large language models, human reviewers, and authors in evaluating STROBE checklist compliance in rheumatology observational studies, highlighting LLMs' potential and limitations.

Contribution

It provides a comparative analysis of LLMs, human reviewers, and authors in assessing STROBE adherence, revealing LLMs' strengths in simple checks and weaknesses in complex evaluations.

Findings

LLMs achieved complete agreement on formatting elements.

Agreement was high for Presentation and Context domains.

Lower agreement observed on complex methodological items.

Abstract

Introduction: Evaluating compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement can be time-consuming and subjective. This study compares STROBE assessments from large language models (LLMs), a human reviewer panel, and the original manuscript authors in observational rheumatology research. Methods: Guided by the GRRAS and DEAL Pathway B frameworks, 17 rheumatology articles were independently assessed. Evaluations used the 22-item STROBE checklist, completed by the authors, a five-person human panel (ranging from junior to senior professionals), and two LLMs (ChatGPT-5.2, Gemini-3Pro). Items were grouped into Methodological Rigor and Presentation and Context domains. Inter-rater reliability was calculated using Gwet's Agreement Coefficient (AC1). Results: Overall agreement across all reviewers was 85.0% (AC1=0.826). Domain stratification showed almost perfect agreement for Presentation and Context (AC1=0.841) and substantial agreement for Methodological Rigor (AC1=0.803). Although LLMs achieved complete agreement (AC1=1.000) with all human reviewers on standard formatting elements, their agreement with human reviewers and authors declined on complex items. For example, regarding the item on loss to follow-up, the agreement between Gemini 3 Pro and the senior reviewer was AC1=-0.252, while the agreement with the authors was only fair. Additionally, ChatGPT-5.2 generally demonstrated higher agreement with human reviewers than Gemini-3Pro on specific methodological items. Conclusion: While LLMs show potential for basic STROBE screening, their lower agreement with human experts on complex methodological items likely reflects a reliance on surface-level information. Currently, these models appear more reliable for standardizing straightforward checks than for replacing expert human judgment in evaluating observational research.