Pediatric fire deaths in Ontario: retrospective study of behavioural, social, and environmental risk factors.

OBJECTIVE To identify the predictors of residential fire deaths in the Ontario pediatric population using systematically collected data from the Office of the Chief Coroner. DESIGN Retrospective cohort study. SETTING Ontario. PARTICIPANTS Children younger than 16 years of age who died in accidental residential fires in Ontario between January 1, 2001, and December 31, 2006. MAIN OUTCOME MEASURES The study retrospectively reviewed the coroner's case files for 60 subjects who qualified according to the selection criteria. Reviewed documents included the coroner's investigation statements, autopsy reports, toxicology reports, fire marshal's reports, police reports, and Children's Aid Society (CAS) reports. Information on a range of demographic, behavioural, social, and environmental factors was collected. Statistical tests, including relative risk, relative risk confidence intervals, and χ(2) tests were performed to determine the correlation between factors of interest and to establish their significance. RESULTS Thirty-nine fire events resulting in 60 deaths occurred between 2001 and 2006. Fire play and electrical failures were the top 2 causes of residential fires. More fires occurred during the night (midnight to 9 AM) than during the day (9 AM to midnight). Nighttime fires were most commonly due to electrical failures or unattended candles, whereas daytime fires were primarily caused by unsupervised fire play and stove fires. Smoke alarms were present at 32 of 39 fire events (82%), but overall alarm functionality was only 54%. Children from families with a history of CAS involvement were approximately 32 times more likely to die in fires. CONCLUSION Risk factors for pediatric fire death in Ontario include smoke alarm functionality, fire play, fire escape behaviour, and CAS involvement. Efforts to prevent residential fire deaths should target these populations and risk factors, and primary care physicians should consider education around these issues as a primary preventive strategy for families with young children.