QUADAS-3 is the current version of QUADAS and the tool that we recommend for use in systematic reviews to assess the risk of bias and applicability of primary test accuracy studies for diagnosis, screening or staging disease.
QUADAS-3 was developed based on feedback from users and systematic reviews that have used QUADAS-2, developments in more recent risk-of-bias tools, methodological studies that have evaluated QUADAS-2, and modifications made to the tool for Cochrane.
The QUADAS-3 tool incorporates several changes compared with the previous version (QUADAS-2) which we hope will improve its validity, usability, and usefulness:
- Assessment of risk of bias and applicability concerns at the estimate level rather than the study level (phase 4)
- Definition of (multiple) synthesis questions
- Introduction of the ideal test accuracy trial to aid with the assessment of applicability and to focus the risk-of-bias assessments
- Formal section for overall judgment
- Improvements to domains and signaling questions
QUADAS-3 was published in Annals of Internal Medicine in February 2026. To cite the QUADAS-3 tool use:
Whiting PF, Tomlinson E, Rutjes AWS, et al. QUADAS-3: A revised tool for the quality assessment of diagnostic test accuracy studies. Ann Intern Med. 17 February 2026. [Epub ahead of print]. doi:10.7326/ANNALS-25-02104