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Alarming increase in MRI, CT Use in Emergency Departments Raise Questions

By MedImaging International staff writers
Posted on 25 Oct 2010

A dramatic rise in the utilization of medical imaging in emergency departments when seeing patients with injuries has not paid off with an equal rise in diagnosing life-threatening conditions or follow-up hospital admissions, according to researchers.

A team of Johns Hopkins researchers reported their findings in a study published in the October 6, 2010 issue of the Journal of the American Medical Association (JAMA). The research group, lead by Frederick Kofi Korley, M.D., an emergency physician and assistant professor at Johns Hopkins [University] Medicine (Baltimore, MD, USA) reviewed emergency department data collected nationally over a 10-year period, 1998 to 2007. The Hopkins team found that patients with injury-related conditions were three times more likely to get a computerized tomography (CT) or magnetic resonance imaging (MRI) scan in 2007 than they were in 1998.

During the same 10-year period, the Johns Hopkins team found that diagnosis of life-threatening conditions, such as a cervical spine fracture or liver laceration, increased only slightly. There was virtually no change in the proportion of hospital admissions for patients seen in emergency departments for injury-related conditions in the same time span.

Dr. Korley and Hopkins colleagues Thomas D. Kirsch, M.D, an emergency physician and associate professor, and Julius Cuong Pham, M.D., an emergency physician and assistant professor in the department of anesthesiology and critical care medicine, studied the data. They reported that analyzing the trend is important because increased medical imaging contributes to radiation exposure and may lead to higher healthcare costs. "The carcinogenic effects of exposure to CT are especially important in patients presenting with injury-related conditions because they tend to be younger and receive multiple CTs,” the authors wrote in their report.

The authors also noted in their study that an indirect effect of increased use of CT is "increased length of visit in the emergency departments due to the long waiting period for imaging results. This can contribute to emergency department crowding and can increase the risk of medical error.”

The Johns Hopkins researchers noted that many factors may have contributed to the spike in the use of CT and MRI scans in U.S. emergency departments. "Some factors that may have contributed to this significant increase in CT use are the superiority of CT scans over X-rays for diagnosing conditions such as cervical spine fractures, the routine use of whole-body scanning for patients treated in some trauma centers, the increased availability of CT scanners, the proximity of CT scanners to the patient care areas of most emergency departments, the speed of new-generation CT scanners leading to a decrease in the need to sedate pediatric patients, and concern about malpractice lawsuits for a missed diagnosis,” the authors wrote.

The team recommended that further study be undertaken on the issue to better understand the reasons for this increase and provide guidance on how physicians can continue to provide excellent emergency care cost-effectively. "Further work is needed to understand the patient, hospital, and physician factors responsible for this increase...and to optimize the risk-benefit balance of advanced radiology use,” the authors concluded.

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63 (345.94535827637): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

64 (44.107437133789): select jos_twitters.link from jos_twitters where cat=10

65 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

66 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

67 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

68 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE id=294731688 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294731688 AND published='1' LIMIT 1

69 (31.948089599609): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (265.12145996094): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731688 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (216.96090698242): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731688 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (37.908554077148): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (42.200088500977): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731688 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731688 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (32.901763916016): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (81.062316894531): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

105 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

106 (50.783157348633): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294731688 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (47.922134399414): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294731688 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

109 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

110 (63.180923461914): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294731688 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (527.85873413086): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294731688 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (540.01808166504): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (339.98489379883): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

115 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

116 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

117 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

118 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

119 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

120 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

121 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

122 (290.87066650391): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 85154.056549072): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 2880.8116912842): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731688 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731688 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 27489.900588989): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (66.041946411133): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (314.95094299316): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (60.081481933594): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (35.04753112793): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (!!!!! 1847.0287322998): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (448.94218444824): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (486.13548278809): SELECT name FROM jos_deeppockets WHERE id=211

138 (36.001205444336): SELECT name FROM jos_deeppockets WHERE id=211

139 (562.90626525879): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (459.19418334961): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (638.96179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

142 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

143 (!!!!! 10878.086090088): TRUNCATE TABLE jos_trademed_module

144 (82.969665527344): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294731688 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (769.13833618164): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294731688 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1770.9732055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 1013.9942169189): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

149 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

150 (!!!!! 1137.0182037354): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (!!!!! 4700.8991241455): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

152 (!!!!! 1518.0110931396): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

153 (422.00088500977): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731688 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731688 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (430.10711669922): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (38.862228393555): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (37.908554077148): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

158 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731688 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731688 AND published='1' LIMIT 1

159 (41.961669921875): select jos_twitters.link from jos_twitters where cat=10

160 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

161 (52.928924560547): select jos_google_plus.link from jos_google_plus where cat=10

162 (38.862228393555): select jos_linkedin.link from jos_linkedin where cat=10

163 (365.9725189209): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (952.00538635254): insert into jos_banners_delta values (14615,'2025-06-27 21:34:53','216.73.216.249','view'),(14202,'2025-06-27 21:34:53','216.73.216.249','view'),(14203,'2025-06-27 21:34:53','216.73.216.249','view')

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