Supplementary Material for: ChatGPT-4o in risk of bias assessments in neonatology – a validity analysis

Background: Only a few studies have addressed the potential of large language models (LLM) in risk of bias assessments and the results have been varying. The aim of this study was to analyze how well ChatGPT performs in risk of bias assessments of neonatal studies. Methods: We searched all Cochrane neonatal intervention reviews published in 2024 and extracted all risk of bias assessments. Then the full reports were retrieved and uploaded alongside the guidance to perform a Cochrane original risk of bias analysis in ChatGPT-4o. The concordance between the original assessment and that provided by ChatGPT-4o was evaluated by inter-class correlation coefficients and Cohen’s Kappa statistics (with 95% confidence intervals for each risk of bias domain and for the overall assessment. Results: From nine reviews a total of 61 randomized studies were analyzed. A total of 427 judgements were compared. The overall kappa was 0.43 (95%CI 0.35-0.51) and the overall intraclass correlation coefficient was 0.65 (95%CI: 0.59-0.70). The Cohen’s kappa was assessed for each domain and the best agreement was observed in the allocation concealment (kappa=0.73, 95%CI: 0.55-0.90), whereas the poorest agreement was found in incomplete outcome data (kappa=-0.03, 95%CI: -0.07-0.02). Conclusion: ChatGPT-4o failed to achieve sufficient agreement in the risk of bias assessments. Future studies should examine whether the performance of other LLM would be better or whether the agreement in ChatGPT-4o could be further enhanced by better prompting. Currently the use of ChatGPT-4o in risk of bias assessments should not be promoted.