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The AFAST‐applied fluid scoring system is a simple and easy to remember 0–4 scoring system developed over a decade ago (Lisciandro et al. 2009). Originally, each AFAST view was scored as 0 being negative or 1 being positive; however, the abdominal fluid scoring system has been further modified, explained subsequently based on more recent studies (Romero et al. 2015; Lisciandro et al. 2019). With this system, an abdominal fluid score (AFS) of 1 was defined as positive at any single AFAST view, an AFS of 2 was positive at any two views, an AFS of 3 was positive at any three views, and the maximum AFS of 4 was positive at all four views (Figure 7.1). The impact of assigning an AFS is that in bleeding patients, an AFS of 1 and 2 is characterized as major injury/pathology, “small‐volume bleeder.” In contrast, an AFS 3 and 4 are characterized as major injury/pathology, “large‐volume bleeder” (Lisciandro et al. 2009; Lisciandro 2011, 2012). “Small‐volume” versus “large‐volume” effusions may also be semiquantitated regarding fluid loss (third spacing) into the abdominal cavity.

Figure 7.1. AFAST‐applied abdominal fluid scoring system. Calculating the abdominal fluid score (AFS) using the AFAST‐applied fluid scoring system shown on a cat placed in right lateral recumbency as a 0–4 system (the same system applies analogously to left lateral recumbency and to dogs). An AFS of 1 is a positive at any single view, an AFS 2 as any combination of two views, an AFS 3 as any combination of three views, and the maximum AFS of 4 when positive at all four views. Note the author has recently modified the AFS by assigning a score of ½ at views that have smaller pockets with maximum dimensions of ≤1 cm or >1 cm in dogs and ≤0.5 cm or >0.5 cm in cats based on more recent research (see Figure 7.2) (Romero et al. 2015; Lisciandro et al. 2019).

Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX. Illustration by Hannah M. Cole, Adkins, TX.