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Whole-Body CT Scans Can Verify But Not Rule Out Injuries in Patients with Major Trauma

By MedImaging International staff writers
Posted on 21 Mar 2012

For evaluating severe trauma, single-pass whole-body computed tomography (CT) imaging can confirm but not conclusively rule out the presence of injuries and should be performed later than 30 minutes after admission to an emergency department for optimal outcomes, according to a recent study.

The study’s findings were published ahead of print March 5, 2012, in the Canadian Medical Association Journal (CMAJ). Traumatic injury, caused by major traffic collisions or a fall from a height, for example, has a significant impact on health care costs, illness, and death. In North America and Europe, it is one of the top 10 causes of disease burden. The Canadian National Trauma Registry, which contains data from eight of Canada’s 10 provinces, registered 14 065 major injuries between 2008 and 2009.

“Recognize first what kills first” is the adage of imaging during the resuscitation period in patients with major trauma. Whole-body CT scanning has been used since the late 1990s to speed injury diagnosis, but there has been criticism that patients are being overexposed to radiation with increasing and general use. The reliability of positive and negative findings of this promising diagnostic application has not been determined to date.

German researchers conducted a study to determine the effectiveness of whole-body or pan-scan imaging in identifying injuries in various parts of the body in trauma patients. They looked at data from 982 trauma patients who had been immediately transferred to the emergency department at the Unfallkrankenhaus Berlin (Berlin, Germany), a metropolitan trauma center, after injury between July 2006 and November 2008.

The team discovered that 360 patients (36.7%) were diagnosed with multiple trauma; 77 (7.8%) of pan-scans were found to be unnecessary, and selective scanning would have been adequate in these cases. In 62 patients (6.3%), the pan-scan missed injuries that required monitoring in the intensive care unit or surgical treatment.

“We found that single-pass whole-body computed tomography is very effective (or specific) at determining where there is injured tissue but is variable in excluding injuries in patients with suspected blunt trauma,” stated lead author Dr. Dirk Stengel, Center for Clinical Research, Unfallkrankenhaus Berlin and Ernst Moritz Arndt University Medical Center. “Screening tests in trauma are intended to immediately detect life-threatening injuries. Given this premise, high specificity--meaning that a positive test result shows injury--makes pan-scanning a valuable tool for priority-oriented treatment.”

However, most scans are performed too early and may miss significant injuries to organs. “The pan-scan performs best 30 minutes after admission, because the sensitivity of the scan increases after this interval,” stated Dr. Stengel. “The transfusion of fluids, blood, plasma, and emergency interventions to stabilize circulation will restore organ perfusion, and make bleedings and hematomas visible on CT scans.”

Healthcare teams should verify negative results to rule out false-negative results with further clinical observation, follow-up examination, or additional imaging, according to the researchers. “Pan-scan algorithms reduce, but do not eliminate, the risk of missed injuries, and should not replace close monitoring and clinical follow-up of patients with major trauma,” concluded the authors.

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63 (46.014785766602): 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 (38.862228393555): select jos_twitters.link from jos_twitters where cat=10

65 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

66 (30.040740966797): 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 (30.994415283203): SELECT fid FROM jos_deeppockets WHERE id=294739898 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739898 AND published='1' LIMIT 1

69 (30.994415283203): 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 (200.98686218262): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739898 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (153.0647277832): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739898 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (38.14697265625): 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 (86.784362792969): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (74.863433837891): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739898 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (42.915344238281): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739898 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (46.968460083008): 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 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): 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 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (80.82389831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

105 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

106 (55.074691772461): 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=294739898 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (58.889389038086): 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=294739898 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (89.168548583984): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

109 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

110 (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.id=294739898 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (471.83036804199): 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=294739898 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (658.03527832031): 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 (373.84033203125): 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 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

115 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

116 (49.829483032227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

117 (37.193298339844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

118 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

119 (35.04753112793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

120 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

121 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

122 (191.92695617676): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 21817.207336426): 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 (533.8191986084): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739898 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739898 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (69.141387939453): ( 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 (41.007995605469): ( 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 (43.869018554688): 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 (36.001205444336): 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 (79.870223999023): 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 (39.100646972656): 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 (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

132 (35.04753112793): 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 (41.007995605469): 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 (34.809112548828): 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 (401.97372436523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (318.05038452148): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (45.061111450195): SELECT name FROM jos_deeppockets WHERE id=211

138 (28.848648071289): SELECT name FROM jos_deeppockets WHERE id=211

139 (632.04765319824): 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 (578.16505432129): 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 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

142 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

143 (!!!!! 9001.0166168213): TRUNCATE TABLE jos_trademed_module

144 (139.95170593262): 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=294739898 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (81.062316894531): 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=294739898 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (561.95259094238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

149 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

150 (!!!!! 1605.0338745117): 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 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

152 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

153 (48.160552978516): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739898 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739898 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (51.975250244141): 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 (44.107437133789): 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 (79.870223999023): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

158 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739898 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739898 AND published='1' LIMIT 1

159 (42.915344238281): select jos_twitters.link from jos_twitters where cat=10

160 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

161 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

162 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

163 (283.95652770996): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1076.2214660645): insert into jos_banners_delta values (14615,'2025-08-19 21:04:28','216.73.216.0','view'),(14202,'2025-08-19 21:04:28','216.73.216.0','view'),(14203,'2025-08-19 21:04:28','216.73.216.0','view')

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