A Peek behind the Curtain: Peer Review and Editorial Decision Making at Stroke

Objective: A better understanding of the manuscript peer-review process could improve the likelihood that research of the highest quality is funded and published. To this end, we aimed to assess consistency across reviewers' recommendations, agreement between reviewers' recommendations and editors' final decisions, and reviewer-and editor-level factors influencing editorial decisions at the journal Stroke. Methods: We analyzed all initial original contributions submitted to Stroke from January 2004 through December 2011. All submissions were linked to the final editorial decision (accept vs reject). We assessed the level of agreement between reviewers (intraclass correlation coefficient). We compared the initial editorial decision (accept, minor revision, major revision, and reject) across reviewers' recommendations. We performed a logistic regression analysis to identify reviewer-and editor-related factors associated with acceptance as the final decision. Results: Of 12,902 original submissions to Stroke during the 8-year study period, the level of agreement between reviewers was between fair and moderate (intraclass correlation coefficient = 0.55, 95% confidence interval [CI] 0.09-0.75). Likelihood of acceptance was <5% if at least 1 reviewer recommended a rejection. In the multivariate analysis, higher reviewer-assigned priority scores were related to greater odds of acceptance (odds ratio [OR]=526.3, 95% CI = 23.2-29.8), whereas higher number of reviewers (OR = 0.54 per additional reviewer, 95% CI= 0.50-0.59) and suggestions for reviewers by authors versus no suggestions (OR = 0.83, 95% CI = 0.73-0.94) had lesser odds of acceptance. Interpretation: This analysis of the peer-review process at Stroke identified several factors that might be targeted to improve the consistency and fairness of the overall process.