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Increase in CT Scans Seen in Emergency Departments

By MedImaging International staff writers
Posted on 20 Dec 2010

A new study reports that the use of computed tomography (CT) in the emergency departments in the United States is growing exponentially. More...

If the growth trend continues, by 2011, almost 20% of all emergency department (ED) visits may involve a CT exam.

The study's findings were presented at the annual meeting of the Radiological Society of North America (RSNA), held November 28 to December 3, 2010 in Chicago, IL, USA, and published online in November 2010 and in the journal Radiology. "It is not surprising that CT utilization has increased,” said lead researcher David B. Larson, MD, MBA, director of quality improvement in the department of radiology at Cincinnati Children's Hospital Medical Center (OH,USA). "What's surprising is the sustained high rate of that growth. However, recent developments, such as increased awareness of cost, radiation concerns, national health care reform legislation and the economic recession, are likely to inhibit further growth.”

The investigators used data collected by the US National Hospital Ambulatory Medical Care Survey from 1995 through 2007 to identify nationwide trends associated with CT utilization in the ED. The researchers performed statistic analysis on a mean of 30,044 ED visits from each year over the 13-year period to estimate overall usage of CT in the ED. "We have seen a remarkable growth in CT utilization, not only in the number of ED visits that involve CT imaging but in the percentage of patients walking into the ED that receive a CT,” Dr. Larson noted.

According to the analysis, the number of ED visits that included a CT exam increased from 2.7 million in 1995 to 16.2 million in 2007, a 5.9-fold increase, and an average growth rate of 16% per year. The percentage of ED visits involving a CT exam increased from 2.8% in 1995 to 13.9% in 2007. "CT is a wonderful technique that is widely available,” Dr. Larson said. "Over the 13 years in our study, image resolution improved significantly, making CT a great tool to look for kidney stones, appendicitis, and coronary artery disease.”

For much of the 13-year period studied, headache was the complaint most commonly associated with a CT exam in the ED. But by 2007, headache was surpassed by abdominal pain as the complaint most frequently associated with CT imaging. In 2007, patients with abdominal pain represented 12.8% of all ED visits involving CT.

CT exams to investigate abdominal pain have a higher radiation dose than CT exams used to determine the cause of a headache. The study revealed that, overall, the use of CT for complaints that are usually related to exams with a higher radiation dose grew faster than those typically related to exams with a lower radiation dose. This suggests that the radiation dose associated with CT in the ED may be growing at a faster rate than the growth in the overall use of CT.

In 1995, a patient visiting the ED with chest pain rarely received a CT exam. However, by 2007, chest pain was the third most typical complaint in the ED associated with CT imaging. "Our emphasis now should be on carefully evaluating the use of CT in specific situations and making sure it is used appropriately,” Dr. Larson said.

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60 (192.16537475586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

61 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

62 (138.0443572998): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

63 (591.99333190918): SELECT fid FROM jos_deeppockets WHERE id=294732580 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294732580 AND published='1' LIMIT 1

64 (51.021575927734): 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`

65 (54.121017456055): select jos_twitters.link from jos_twitters where cat=10

66 (37.908554077148): select jos_facebook.link from jos_facebook where cat=10

67 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

68 (35.04753112793): select jos_linkedin.link from jos_linkedin where cat=10

69 (40.054321289062): SELECT fid FROM jos_deeppockets WHERE id=294732580 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294732580 AND published='1' LIMIT 1

70 (37.908554077148): 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`

71 (504.0168762207): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294732580 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (363.11149597168): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294732580 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (59.843063354492): 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`

74 (80.82389831543): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (49.829483032227): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (82.969665527344): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294732580 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (46.014785766602): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294732580 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (47.922134399414): 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`

91 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (117.77877807617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

106 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

107 (77.962875366211): 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=294732580 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (66.041946411133): 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=294732580 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (116.82510375977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

110 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

111 (79.154968261719): 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=294732580 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (770.09201049805): 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=294732580 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (797.98698425293): 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 (557.89947509766): 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

115 (144.95849609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

116 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

117 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

118 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

119 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

120 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

121 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

122 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

123 (404.11949157715): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 28175.830841064): 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

125 (733.85238647461): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294732580 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294732580 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 10500.907897949): ( 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 (139.95170593262): ( 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

128 (66.995620727539): 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 (42.915344238281): 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

130 (88.930130004883): 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 (41.007995605469): 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

132 (419.13986206055): 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 (64.13459777832): 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

134 (51.021575927734): 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 (42.915344238281): 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

136 (607.01370239258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (487.08915710449): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (50.067901611328): SELECT name FROM jos_deeppockets WHERE id=211

139 (39.100646972656): SELECT name FROM jos_deeppockets WHERE id=211

140 (754.83322143555): 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 (687.1223449707): 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

142 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

143 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

144 (!!!!! 10370.016098022): TRUNCATE TABLE jos_trademed_module

145 (135.18333435059): 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=294732580 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (87.976455688477): 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=294732580 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (643.01490783691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

150 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

151 (!!!!! 1668.9300537109): 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

152 (126.12342834473): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

153 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

154 (60.081481933594): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294732580 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294732580 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (46.968460083008): 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 (42.915344238281): 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)

157 (73.909759521484): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

159 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732580 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732580 AND published='1' LIMIT 1

160 (56.982040405273): select jos_twitters.link from jos_twitters where cat=10

161 (38.862228393555): select jos_facebook.link from jos_facebook where cat=10

162 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

163 (133.99124145508): select jos_linkedin.link from jos_linkedin where cat=10

164 (414.13307189941): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

165 (!!!!! 1299.8580932617): insert into jos_banners_delta values (14615,'2025-08-20 14:44:47','216.73.216.0','view'),(14202,'2025-08-20 14:44:47','216.73.216.0','view'),(14203,'2025-08-20 14:44:47','216.73.216.0','view')

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