Abstract
BACKGROUND: Manual quality assessment of systematic reviews is labor-intensive, time-consuming, and subject to reviewer bias. With recent advances in large language models (LLMs), it is important to evaluate their reliability and efficiency as potential replacements for human reviewers. AIM: This study assessed whether generative AI models can substitute for manual reviewers in literature quality assessment by examining rating consistency, time efficiency, and discriminatory performance across four established appraisal tools. METHODS: Ninety-one systematic reviews were evaluated using AMSTAR 2, CASP, PEDro, and RoB 2 by both human reviewers and two LLMs (ChatGPT-4.0 and DeepSeek R1). Entropy-based indicators quantified rating consistency, while Spearman correlations, receiver operating characteristic (ROC) analysis, and processing-time comparisons were used to assess the relationship between time variability and scoring reliability. RESULTS: The two LLMs demonstrated high consistency with human ratings (mean entropy = 0.42), with particularly strong alignment for PEDro (0.17) and CASP (0.25). Average processing time per article was markedly shorter for LLMs (33.09 s) compared with human reviewers (1,582.50 s), representing a 47.80-fold increase in efficiency. Spearman correlation analysis showed a statistically significant positive association between processing-time variability and rating entropy (ρ = 0.24, p = 0.026), indicating that greater time variability was associated with lower consistency. ROC analysis further showed that processing-time variability moderately predicted moderate-to-low consistency (AUC = 0.65, p = 0.045), with 46.00 seconds identified as the optimal cutoff threshold. CONCLUSION: LLMs markedly reduce appraisal time while maintaining acceptable rating consistency in literature quality assessment. Although human validation is recommended for cases with high processing-time variability (>46.00 s), generative AI represents a promising approach for standardized, efficient, and scalable quality appraisal in evidence synthesis.