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Most Children with Normal CT Scans Need Not Be Hospitalized After Blunt Head Trauma

By MedImaging International staff writers
Posted on 20 Jul 2011

A large, US multicenter study of thousands of children taken to emergency departments with minor blunt head trauma has found that most of those with normal computed tomography (CT) scans do not require hospitalization for further observation.

Of the more than 13,500 children included in the study, less than 1% had subsequent abnormal CT scans or magnetic resonance imaging (MRI) scans and none required neurosurgical intervention.

The study was conducted under the auspices of the groundbreaking Pediatric Emergency Care Applied Research Network (PECARN), and was published online on June 17, 2011, in the journal Annals of Emergency Medicine. “We now have definitive evidence supporting discharging most neurologically normal children with head trauma after negative CT scans home from the emergency department,” said James Homes, professor of emergency medicine in the University of California (UC) Davis School of Medicine (USA) and the study’s lead author and coinvestigator. “Sending these patients home with their parents not only provides good, safe care but it also saves costs. It is a win for everyone concerned.”

While blunt head trauma is the leading cause of death in children older than one year old, the authors said the finding shows that children with minor blunt head trauma with normal CT scans are at very low risk for subsequent traumatic findings on neuroimaging. More importantly, they are at extremely low risk of needing neurosurgical intervention.

Nevertheless, children fitting this profile frequently are admitted to hospitals for additional observation following normal CT scans. The study authors concluded, “Hospitalization of children with minor head trauma after normal CT scan results for neurologic observation is generally unnecessary.”

“One of the goals in the evaluation of children with minor head trauma is to try to avoid CT scan use, if possible. If you do a CT scan and the scan is negative, and the child is well, then for goodness sakes let the child go home,” said study senior author Dr. Nathan Kuppermann, professor of pediatrics and emergency medicine and chair of the department of emergency medicine in the UC Davis School of Medicine. “Admitting these children after normal CT scans is costly, causes them to spend time away from their families and loved ones, and potentially exposes them to other health risks, such as hospital-borne infections,” Dr. Kuppermann said.

Dr. Kuppermann is founding chair and a lead investigator of PECARN, the first US-funded pediatric emergency research network in the country, and oversees the Academic Centers Research Node. In addition to UC Davis, the group includes hospitals in Milwaukee, WI, Philadelphia, PA; St. Louis, MO; Cincinnati, OH, and Salt Lake City, UT. He also is the lead investigator of the PECARN head injury study published in the journal the Lancet in 2009, from which the current study is derived.

Children frequently are admitted to the hospital for additional observation after blunt head trauma to allow frequent neurologic examinations. However, studies in adults have found that neurologic problems following minor blunt head trauma are rare and that hospitalization after a normal cranial CT scan is unnecessary.

Enrolled in the study were 13,543 children 18 years old or younger with minor blunt head trauma who were treated in 25 emergency departments across the United States from June 2004 to September 2006. The patients’ median age was about nine years old; 63% were boys. The study included both children with “isolated head trauma” and head trauma and other injuries.

For the study, the authors obtained initial CT results for each patient. Study participants were considered to have normal CT scans if their radiologic scans did not reveal intracranial hemorrhage, cerebral concussion, cerebral edema, or skull fractures. Those who were discharged from the emergency department received follow-up telephone calls at least one week after their emergency department visit, to determine whether their child received additional CT or MRI scans. Their families also were asked about neurologic complications, including neurosurgical interventions. Nearly 80% of the study participants were reached for follow-up by either telephone or mail. Those who were hospitalized were followed during their hospitalization for any deterioration.

Hundreds of the patients who were either hospitalized or discharged were found to have received repeated neuroimaging--either CT scans or MRIs or both--but none of the patients required neurosurgical intervention, indicating that there is a very low risk for patients to deteriorate after an initially normal cranial CT scan.

The authors noted that the children involved in the study may have required hospitalization for injuries that were not confined to the head and some also may have been vomiting and so admitted for intravenous fluid administration. But of the patients hospitalized, more than half only had blunt head trauma and no other injuries or ailments, and most were in all probability hospitalized simply for neurologic observation.

Related Links:
University of California Davis School of Medicine

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57 (!!!!! 1485.1093292236): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

58 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

59 (!!!!! 4356.861114502): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

60 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

61 (!!!!! 3324.031829834): 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

62 (543.83277893066): SELECT fid FROM jos_deeppockets WHERE id=294736180 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736180 AND published='1' LIMIT 1

63 (427.0076751709): 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 (368.11828613281): select jos_twitters.link from jos_twitters where cat=10

65 (44.107437133789): select jos_facebook.link from jos_facebook where cat=10

66 (165.22407531738): select jos_google_plus.link from jos_google_plus where cat=10

67 (38.14697265625): select jos_linkedin.link from jos_linkedin where cat=10

68 (262.02201843262): SELECT fid FROM jos_deeppockets WHERE id=294736180 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736180 AND published='1' LIMIT 1

69 (315.90461730957): 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 (!!!!! 4853.0101776123): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736180 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (449.89585876465): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736180 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 1574.9931335449): 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 (64.849853515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (168.0850982666): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (98.943710327148): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (92.983245849609): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (118.01719665527): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (440.12069702148): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (162.12463378906): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736180 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (173.09188842773): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736180 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (111.81831359863): 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 (78.201293945312): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (80.82389831543): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

105 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

106 (74.148178100586): 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=294736180 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (63.896179199219): 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=294736180 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (802.04010009766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

109 (!!!!! 2101.8981933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

110 (69.856643676758): 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=294736180 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (737.90550231934): 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=294736180 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (728.84559631348): 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 (471.83036804199): 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 (128.98445129395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

115 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

116 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

117 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

118 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

119 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

120 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

121 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

122 (338.07754516602): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 26811.838150024): 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 (591.99333190918): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736180 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736180 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 9778.9764404297): ( 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 (100.85105895996): ( 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 (85.115432739258): 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 (45.061111450195): 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 (52.928924560547): 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 (37.908554077148): 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 (377.89344787598): 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 (56.028366088867): 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 (44.822692871094): 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 (568.86672973633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (398.87428283691): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (263.92936706543): SELECT name FROM jos_deeppockets WHERE id=211

138 (42.915344238281): SELECT name FROM jos_deeppockets WHERE id=211

139 (825.88195800781): 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 (684.02290344238): 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 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

142 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

143 (!!!!! 9055.8528900146): TRUNCATE TABLE jos_trademed_module

144 (118.97087097168): 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=294736180 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (72.956085205078): 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=294736180 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1116.9910430908): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

149 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

150 (!!!!! 1531.8393707275): 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 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

152 (65.803527832031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

153 (80.108642578125): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736180 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736180 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (46.014785766602): 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 (41.007995605469): 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 (46.968460083008): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (164.98565673828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

158 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736180 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736180 AND published='1' LIMIT 1

159 (51.975250244141): select jos_twitters.link from jos_twitters where cat=10

160 (35.04753112793): select jos_facebook.link from jos_facebook where cat=10

161 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

162 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

163 (511.88468933105): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1163.0058288574): insert into jos_banners_delta values (14615,'2025-06-27 04:23:56','216.73.216.249','view'),(14202,'2025-06-27 04:23:56','216.73.216.249','view'),(14203,'2025-06-27 04:23:56','216.73.216.249','view')

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