title: Diagnostic accuracy study of three alcohol breathalysers marketed for sale to the public.
abstract: To assess the diagnostic accuracy of three personal breathalyser devices available for sale to the public marketed to test safety to drive after drinking alcohol.
  
  
  
  Prospective comparative diagnostic accuracy study comparing two single-use breathalysers and one digital multiuse breathalyser (index tests) to a police breathalyser (reference test).
  
  
  
  Establishments licensed to serve alcohol in a UK city.
  
  
  
  Of 222 participants recruited, 208 were included in the main analysis. Participants were eligible if they were 18 years old or over, had consumed alcohol and were not intending to drive within the following 6 h.
  
  
  
  Sensitivity and specificity of the breathalysers for the detection of being at or over the UK legal driving limit (35 µg/100 mL breath alcohol concentration).
  
  
  
  18% of participants (38/208) were at or over the UK driving limit according to the police breathalyser. The digital multiuse breathalyser had a sensitivity of 89.5% (95% CI 75.9% to 95.8%) and a specificity of 64.1% (95% CI 56.6% to 71.0%). The single-use breathalysers had a sensitivity of 94.7% (95% CI 75.4% to 99.1%) and 26.3% (95% CI 11.8% to 48.8%), and a specificity of 50.6% (95% CI 40.4% to 60.7%) and 97.5% (95% CI 91.4% to 99.3%), respectively. Self-reported alcohol consumption threshold of 5 UK units or fewer had a higher sensitivity than all personal breathalysers.
  
  
  
  One alcohol breathalyser had sensitivity of 26%, corresponding to false reassurance for approximately three people in four who are over the limit by the reference standard, at least on the evening of drinking alcohol. The other devices tested had 90% sensitivity or higher. All estimates were subject to uncertainty. There is no clearly defined minimum sensitivity for this safety-critical application. We conclude that current regulatory frameworks do not ensure high sensitivity for these devices marketed to consumers for a decision with potentially catastrophic consequences.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Helen F
authors.initials: HF
authors.lastname: Ashdown
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Susannah
authors.initials: S
authors.lastname: Fleming
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Spencer
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Thompson
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Stevens
mesh_terms: D000328:Adult; D000435:Alcoholic Intoxication / Q000175:diagnosis*; D001944:Breath Tests / Q000379:methods*; D000431:Ethanol / Q000032:analysis*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D000431:Ethanol