Whiting, Penny FPenny FWhitingRutjes, AnneAnneRutjesWestwood, Marie EMarie EWestwoodMallett, SusanSusanMallettDeeks, Jonathan JJonathan JDeeksReitsma, Johannes BJohannes BReitsmaLeeflang, Mariska M GMariska M GLeeflangSterne, Jonathan A CJonathan A CSterneBossuyt, Patrick M MPatrick M MBossuyt2024-10-112024-10-112011https://boris-portal.unibe.ch/handle/20.500.12422/78041In 2003, the QUADAS tool for systematic reviews of diagnostic accuracy studies was developed. Experience, anecdotal reports, and feedback suggested areas for improvement; therefore, QUADAS-2 was developed. This tool comprises 4 domains: patient selection, index test, reference standard, and flow and timing. Each domain is assessed in terms of risk of bias, and the first 3 domains are also assessed in terms of concerns regarding applicability. Signalling questions are included to help judge risk of bias. The QUADAS-2 tool is applied in 4 phases: summarize the review question, tailor the tool and produce review-specific guidance, construct a flow diagram for the primary study, and judge bias and applicability. This tool will allow for more transparent rating of bias and applicability of primary diagnostic accuracy studies.enarticle10.7892/boris.75902200704600029606630001810.1059/0003-4819-155-8-201110180-00009