Fluid Assessment Scoring Tool (FAST) - Development of a Novel Fluid Assessment Scoring Tool for Critically Ill Pediatric Patients - A Pilot Study

Oct 5, 2026

A pilot study developed the Fluid Assessment Scoring Tool (FAST) to evaluate fluid overload in critically ill children in the pediatric intensive care unit (PICU). Conventional fluid balance assessments are described as challenging, unreliable, or infeasible, and existing composite algorithms are lacking. The study assessed 32 patients (118 encounters) using weighted bedside and imaging indicators and tested FAST cut points against thoracic fluid content (TFC) as a gold standard.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Introduction

Methods

Results

Conclusion

Received 05/07/2025 Review began 07/29/2025 Review ended 09/03/2025 Published 09/11/2025 © Copyright 2025 Salameh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.92067 Open Access Original Article Fluid Assessment Scoring Tool (FAST) : Development of a Novel Fluid Assessment Scoring Tool for Critically Ill Pediatric Patients—A Pilot Study Mohammed Salameh 1, Pranali Awadhare 2, Jennifer Joiner 3, Michael Scheurer 4, Utpal Bhalala 5, 6, 7 1. Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, USA 2. Pediatrics and Child Health, Driscoll Children 's Hospital, Corpus Christi, USA 3. Pediatric Critical Care Medicine, Methodist Health System, San Antonio, USA 4. Biostatistics and Epidemiology, Baylor College of Medicine, Houston, USA 5. Pediatrics, Texas A &M College of Medicine, College Station, USA 6. Anesthesiology and Critical Care, University of Texas Medical Branch at Galveston, Galveston, USA 7. Anesthesiology and Critical Care, Driscoll Children 's Hospital, Corpus Christi, USA Corresponding author: Mohammed Salameh, [doctor.salameh@gmail.com](doctor.salameh@gmail.com) Abstract Introduction Monitoring fluid balance (FB) is important yet challenging in the pediatric intensive care unit (PICU) . Currently used, conventional methods of fluid assessment are either not feasible or unreliable. Also, there is a lack of composite scores or clinical algorithms that use different parameters of fluid status. We aim to develop a fluid assessment scoring tool (FAST) to clinically assess the fluid status of children in the PICU. Methods In this pilot study, we included critically ill patients aged 0-21 years who presented to our PICU between December 2020 and March 2021 and required invasive or non-invasive mechanical ventilation, inotropes, diuretics, and renal replacement therapy. In our study, 32 patients contributed 118 encounters. We assigned scores 0-3 each for fontanelles, eyes, liver exam, daily weight changes, FB, urine output, blood urea nitrogen, creatinine, and chest X-ray findings. We also assigned a score of 0-3 for thoracic fluid content (TFC) as measured by the non-invasive ICON® monitor (Osypka Medical GmbH, Berlin, Germany) . First, anon-parametric receiver operating curve (ROC) analysis was used to determine potential cut points for the FAST using the TFC as a “gold standard.” Cut points were selected based on a balanced sensitivity vs. specificity. Next, a 10-fold cross-validation area under the curve (AUC) for ROC analysis was performed to estimate the best-performing cut-point. Results The median (interquartile range, IQR) age was 78.7 (9 . 75-84) months, and 62 .5% of patients were males. The median (IQR) FAST score was 4 (2-6) . The median (IQR) TFC was 44.5 (29-57.25) . Of the 118 encounters, 78 (66%) exhibited high TFC. The two potential FAST scores predicting a higher TFC that indicates fluid overload (FO) were ≥3 (sensitivity=92%; specificity=68%) and ≥4 (sensitivity=80%; specificity=80%) . On cross-validation, FAST≥3 (AUC=0 . 79) and FAST≥4 (AUC=0 . 78) showed similar performance. When using our FAST cut points to evaluate outcomes, we do not observe significant differences in the median ventilator days, PICU days, or hospital stay days. Conclusion The FAST offers a practical approach to evaluating FO in critically ill pediatric patients. A FAST score ≥3 was associated with TFC-defined FO, suggesting clinical utility. Future multicenter studies are needed to validate its use and explore its impact on patient outcomes. Categories: Other, Nephrology, Pediatrics Keywords: children, fluid assessment, fluid status, pediatric critical care, score Introduction Fluid overload (FO) is associated with poor outcomes in

FAQs

What problem does the FAST address in the PICU?

FAST addresses the difficulty of accurately assessing fluid balance and detecting fluid overload at the bedside in critically ill pediatric patients, where conventional methods can be unreliable or infeasible.

How was FAST developed and validated in this pilot study?

FAST was built by assigning 0–3 scores across multiple bedside and laboratory/imaging indicators, then using receiver operating curve (ROC) analysis with thoracic fluid content (TFC) as the gold standard to determine cut points.

Which FAST scores were associated with fluid overload?

FAST cut points of ≥3 and ≥4 predicted higher TFC indicative of fluid overload, with comparable performance on cross-validation.

Oct 5, 2026

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