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For several years the author has used a modified AFS system to better differentiate between small‐volume and large‐volume bleeder and effusions. The modified system now includes scores of 0, ½, and 1, which we refer to as the measurement approach (Lisciandro et al. 2015, 2019; Romero et al. 2015). The measurement approach categorizes positives as ½ or 1 dependent on the maximum dimension at each AFAST view (Figure 7.2). Based on recent research since the first edition, we suggest an “under–over” of 1 cm (10 mm) in dogs and “under–over” of 0.5 cm (5 mm) in cats (Lisciandro et al. 2015, 2019; Romero et al. 2015). Thus, in a dog, when a maximum dimension at an AFAST view is ≤1 cm, it is scored as a ½, and if >1 cm, it is scored as 1; and in a cat ≤0.5 cm is scored as a ½ and >0.5 cm is scored as a 1 (Figure 7.3; see also 7.8).

Figure 7.2. The “measurement” modification of the AFAST‐applied abdominal fluid scoring system. The figure shows the measurement abdominal fluid scoring (AFS) system. (A,B) Cartoons of a cat in right and left lateral recumbency and (C,D) cartoons of a dog in right and left lateral recumbency. The modification of the AFS better distinguishes between “small‐volume” and “large‐volume” bleeding (and other forms of nonhemorrhagic effusions) by assigning a score of ½ or 1 dependent on the maximum measured dimension at each AFAST view based on recently published studies (Lisciandro et al. 2015, 2019; Romero et al. 2015). The AFS is validated in either right or left lateral recumbency (Lisciandro et al. 2009). See also Figure 7.3.

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

The “small‐volume bleeder versus large‐volume bleeder” principle remains the same with a 0–4 system as published (Lisciandro et al. 2009); however, the addition of the ½ helps better semiquantitate and categorize the bleeding dog and cat (Lisciandro et al. 2019). The modified fluid scoring system may also be used with nonhemorrhagic effusions since any effusion potentially contributes to volume loss in your patient. Clinical judgment always should be considered along with the patient's entire clinical picture; however, this AFS modification provides an option to better categorize bleeding patients and those with other nonhemorrhagic effusions. For example, a dog may have small pockets at the DH, CC, and HRU views of <1 cm which would now be deemed a small‐volume bleeder (if a bleeding case) with a score of 1½ rather than a 3 (see Figure 7.8).