Background: The waiting list for children to receive cardiac surgery in developing countries is prohibitively long for humanitarian teams to meet all of the needs.
Objectives: We sought to develop a scoring system to identify those children for surgery that would best serve the short- and long-term goals of developing independent cardiac care in underserved countries.
Methods: Preselected children were screened by the pediatric cardiologist of the visiting team. The evaluation included: exam, echocardiogram, and assignment of a FIRST score (5-20 pts). F: Functional status (1-4 pts); I: Improvement after surgery (1-3pts); R: Risk of inoperability (1-4pts); S: Surgical risk (inversely awarded 1-4 pts); T: Teaching opportunities provided by the case (1-4pts). One point was given if an intangible reason for surgery existed. The score for an asymptomatic child with an ASD would be 8.
Results: Seventy-three children were screened for ten surgical slots. Children with a higher FIRST score were given priority. The average FIRST score for the children chosen was 13.15 (11-15.5). Surgeries included repairs of six VSDs, three ASDs, and one PDA. All ten surgeries were successful. There were no major complications and none remained intubated > 24 hours.
Conclusions: The “FIRST” score provides a system by which five separate considerations can be used to guide patient selection. The tool was successfully used to decrease patient selection bias, increase short-term success of the visiting team and improve the ability of international surgical teams to more effectively advance the proficiency of burgeoning programs in pediatric cardiac care.