Response to Reviewers Letter Template

Response to Reviewers: [Manuscript ID and short title]

Point-by-point response letter for a revised journal manuscript: a cover note to the editor, a summary of the main changes, every editor and reviewer comment quoted and answered in turn, a change log that maps each comment to the exact place in the revised manuscript, and a final check before resubmission. Based on common editorial practice and the transparency and courtesy principles of the COPE Core Practices, cited as a reference only. The journal's own revision instructions always take precedence. Replace every [bracketed] value and every row marked Example.

1. Cover note to the editor

Dear [Dr Editor name],

Thank you for the opportunity to revise our manuscript "[Title]" ([Manuscript ID]) and for the careful comments from you and the reviewers. We have answered every comment below, quoting each one in italics followed by our reply and the location of the change in the revised manuscript.

The main changes are:

1. [Example: We re-ran the primary analysis with a model that accounts for repeated visits by the same patient, as requested by Reviewer 1 (R1.1). The direction and size of the main estimate are unchanged.]
2. [Example: We added a sensitivity analysis excluding the 2025 heat season, when a new triage system was introduced (R2.2).]
3. [Example: We shortened the Discussion by about 400 words and removed the policy recommendation that went beyond our data (E2, R2.3).]

[Example: We respectfully did not add the multi-city comparison suggested in R1.4, because data for the other cities are not available under our ethics approval. We explain this in our reply and have added it as a limitation.]

All page and line numbers refer to the revised manuscript with tracked changes. [We confirm that all authors have approved the revised manuscript.]

Yours sincerely, [Corresponding author name, on behalf of all authors]

2. Summary of changes

Other changes not requested by reviewers:

• [Example: Corrected a typing error in Table 2 (the number of visits in the reference group was 12,480, not 12,840); no estimate changed.]
• [Example: Updated two references that have since been published.]

3. Point-by-point responses

3.1 Editor

E1. [Paste the editor's comment. Example: "Please follow the journal's reporting guideline for observational studies and upload the completed checklist."]

Response. [Example: Thank you. We have completed the STROBE checklist for cohort studies and uploaded it as Supplementary File 3. Completing it showed that the handling of missing temperature data was not described, so we added a sentence to the Methods.]

Change. [Example: Methods, section 2.5, page 7, lines 152-155: "Daily maximum temperature was missing for 3 of 1,096 study days; these days were excluded from the analysis."]

E2. [Example: "The Discussion is long and the final paragraph makes policy recommendations that the data cannot support."]

Response. [Example: We agree. We removed the final paragraph and shortened the Discussion from about 1,900 to about 1,500 words.]

Change. [Example: Discussion, pages 15-18; deleted paragraph shown in tracked changes on page 18.]

3.2 Reviewer 1

[Example: We thank Reviewer 1 for the detailed reading of our methods.]

R1.1. [Example: "Patients may visit the emergency department more than once. The model treats visits as independent, which underestimates the standard errors."]

Response. [Example: This is a fair point. We refitted the model with standard errors clustered by patient. The main estimate for adults aged 75 and over is unchanged (rate ratio 1.12) and the 95% confidence interval widened slightly, from 1.08-1.16 to 1.07-1.17.]

Change. [Example: Methods, section 2.6, page 8, lines 170-176 (new text on clustering); Results, Table 3, page 11; Abstract, line 18.]

R1.2. [Comment]

Response. [Response]

Change. [Location and quoted new text]

R1.3. [Example: "Please justify the choice of a 3-day lag window."]

Response. [Example: We chose the 3-day window before analysis, based on the protocol registered on [registry and date]. We kept it as the main analysis and added 0-day and 0-to-7-day windows as a sensitivity analysis. Only part of the request could be met: the protocol did not specify a distributed lag model, so we report it in the supplement and not as a main result.]

Change. [Example: Methods, page 8, lines 178-181; Supplementary Table S4.]

R1.4. [Example: "A comparison with other cities would strengthen the generalisability."]

Response. [Example: We agree that this would be valuable. However, our ethics approval covers only records from the two hospitals in the study area, and we have no lawful access to records from other cities. We have added this as a limitation and suggest it for future work.]

Change. [Example: Discussion, Limitations, page 17, lines 361-364.]

3.3 Reviewer 2

R2.1. [Comment]

Response. [Response]

Change. [Location and quoted new text]

R2.2. [Example: "A new triage system was introduced in 2025. Could this explain part of the effect?"]

Response. [Example: Thank you for raising this. We repeated the analysis excluding the 2025 heat season. The estimate was similar (rate ratio 1.11, 95% CI 1.05-1.17).]

Change. [Example: Results, section 3.4, page 13; Supplementary Table S5.]

R2.3. [Comment]

Response. [Response]

Change. [Location and quoted new text]

4. Change log

5. Working plan for co-authors

6. Writing good responses

• Answer the question asked. Start each reply with a direct answer (agree, partly agree, disagree) before the explanation.
• Show, do not tell. Quote the new sentence or give the new number. Reviewers should not need to search the manuscript.
• Disagree with evidence. Cite data, the registered protocol, the reporting guideline or published methods work. Offer a middle path where one exists, such as a sensitivity analysis or a limitation.
• Keep numbers consistent. When an analysis changes, update the Abstract, Results, tables, figures and supplement together, and say so in the reply.
• Handle conflicting reviewers openly. When two reviewers ask for opposite changes, say which you followed and why, and refer the editor to both replies.
• Do not add new claims quietly. Any new analysis or conclusion goes in the change log so reviewers can judge it.
• Respect confidentiality. Do not share the reviewers' comments outside the author group, and do not try to identify anonymous reviewers.
• Disclose tools. If you used AI-assisted tools to draft replies or revise text, follow the journal's policy and disclose the use as it requires; the authors remain responsible for every statement.

7. Pre-resubmission checklist

• Every editor and reviewer comment has an ID and a reply in section 3
• Section 2 counts match section 3 and the change log
• Every "Change" entry gives section, page and line in the tracked file
• Every declined request gives a reason and, where possible, an alternative
• Abstract, tables, figures and supplement match the revised Results
• Clean and tracked-changes versions are both uploaded, as the journal asks
• Reporting checklists and declarations are updated if the content changed
• All authors have read and approved the revision and the letter
• Internal working plan (section 5) is deleted
• Line numbers were checked after the final edit

8. References

1. [Example: STROBE Statement, checklist for cohort studies, cited in E1.]
2. [Reference cited in a reply]

Revision history

Standard and licence note

Based on common editorial practice for revised manuscripts, with the principles of transparency, fairness and courtesy in the COPE (Committee on Publication Ethics) Core Practices, including peer review and complaints and appeals, cited as a reference only (https://publicationethics.org/core-practices). The reviewer confidentiality item reflects the COPE Ethical Guidelines for Peer Reviewers (https://doi.org/10.24318/cope.2019.1.9). The AI-use item reflects the ICMJE Recommendations (updated January 2026, https://www.icmje.org/recommendations/). Journals set their own revision rules, so follow the decision letter and author instructions, and check the current COPE and ICMJE texts. This template is original text and reproduces no COPE or ICMJE wording. Template licence: MIT.