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Children with Abdominal Pain Increasingly Exposed to CT Scanning in the Emergency Room

By MedImaging International staff writers
Posted on 10 May 2012

Computed tomography (CT) imaging use in children with nontraumatic abdominal pain increased in emergency departments each year between 1999 and 2007, according to new findings.

The study’s authors found no corresponding increase in ultrasound use during the same period, in spite of research supporting it as an important diagnostic tool for assessing pediatric abdominal pain. The study’s findings were published online April 26, 2012, in the journal Radiology.

Nontraumatic abdominal pain is a typical complaint of pediatric visits to the emergency department. Physicians frequently order CT exams when abdominal pain suggests appendicitis. While CT scans provide rapid, accurate diagnosis, they expose patients to ionizing radiation--a significant concern for children due to their longer life expectancy and increased susceptibility to radiation effects.

“Our findings help give us an overall understanding of places where we can tackle disparities of use and disparities in care,” said Anastasia L. Hryhorczuk, MD, a clinical fellow from Children’s Hospital Boston (MA, USA). “Ideally, we’d like to see the same standard of care being applied across the country to protect children from unnecessary radiation exposure.”

Research has shown that step-by-step evaluations of pediatric patients, beginning with ultrasound and proceeding to CT if ultrasound is negative or uncertain, is the most accurate path for diagnosing appendicitis. Dr. Hryhorczuk and colleagues sought to determine if this strategy had been incorporated into general emergency department practices.

For the study, researchers looked at data from the US National Hospital Ambulatory Medical Care Survey (NHAMCS) to evaluate imaging utilization among children with acute abdominal pain in US emergency departments. From 1999 to 2007, there were 16,900,000 pediatric emergency department visits for acute abdominal pain. The chances of a child receiving a CT scan increased during each year of the study period, in spite of the fact that there were no statistically significant changes in ultrasound usage, numbers of patients admitted to the hospital, or numbers of patients with acute appendicitis. Only three percent of patients ultimately diagnosed with appendicitis were imaged with both ultrasound and CT.

Children evaluated in pediatric emergency departments were more than 25% less likely than those seen at general emergency departments to undergo CT imaging for abdominal pain. “In a pediatric setting, clinicians may have skills for evaluating patients that favor management without imaging, lowering CT usage,” Dr. Hryhorczuk said.

Statistical analysis demonstrated increased odds of CT use in teens, white patients, the Midwest region of the United States, urban settings, patients with private insurance, and patients who were admitted or transferred. Although the study did not investigate reasons for these variations, Dr. Hryhorczuk pointed out that CT scanners are readily available in hospitals, whereas access to ultrasound may be limited based on operator availability in some areas. The local legal climate also may play a factor in obtaining imaging exams, according to the study, as appendicitis diagnoses are a source of lawsuits in the pediatric emergency setting.

The time period of the study predates “Image Gently,” a 2008 initiative of the Alliance for Radiation Safety in Pediatric Imaging that promotes radiation safety in the imaging of children. The researchers hope that further study of NHAMCS information will provide more data on the success of this and other programs aimed at lowering medical radiation exposure in children.

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63 (65.088272094727): 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 (84.877014160156): select jos_twitters.link from jos_twitters where cat=10

65 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

66 (36.001205444336): select jos_google_plus.link from jos_google_plus where cat=10

67 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

68 (34.093856811523): SELECT fid FROM jos_deeppockets WHERE id=294740544 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294740544 AND published='1' LIMIT 1

69 (40.054321289062): 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 (458.0020904541): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740544 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (303.98368835449): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740544 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (45.061111450195): 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 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (48.87580871582): 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 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (58.174133300781): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740544 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (32.901763916016): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740544 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.954879760742): 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 (54.121017456055): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (89.168548583984): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

105 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

106 (77.009201049805): 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=294740544 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (67.949295043945): 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=294740544 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

109 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

110 (56.028366088867): 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=294740544 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (627.04086303711): 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=294740544 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (664.94941711426): 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 (504.0168762207): 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 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

115 (155.92575073242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

116 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

117 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

118 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

119 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

120 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

121 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

122 (335.9317779541): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 29103.04069519): 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 (699.04327392578): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740544 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740544 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 9990.930557251): ( 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 (188.82751464844): ( 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 (199.0795135498): 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 (61.03515625): 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 (63.180923461914): 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 (30.994415283203): 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 (472.06878662109): 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 (49.114227294922): 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 (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

134 (30.994415283203): 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 (570.05882263184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (526.90505981445): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (53.882598876953): SELECT name FROM jos_deeppockets WHERE id=211

138 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=211

139 (637.05444335938): 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 (545.02487182617): 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 (85.830688476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

142 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

143 (!!!!! 13355.016708374): TRUNCATE TABLE jos_trademed_module

144 (128.03077697754): 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=294740544 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (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_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=294740544 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (652.07481384277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (123.97766113281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

149 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

150 (!!!!! 1600.980758667): 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 (104.18891906738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

152 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

153 (53.882598876953): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740544 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740544 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (43.869018554688): 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 (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)

156 (61.988830566406): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (104.18891906738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

158 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740544 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740544 AND published='1' LIMIT 1

159 (45.061111450195): select jos_twitters.link from jos_twitters where cat=10

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

161 (33.140182495117): select jos_google_plus.link from jos_google_plus where cat=10

162 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

163 (303.03001403809): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1301.0501861572): insert into jos_banners_delta values (14615,'2025-08-19 19:40:54','216.73.216.0','view'),(14202,'2025-08-19 19:40:54','216.73.216.0','view'),(14203,'2025-08-19 19:40:54','216.73.216.0','view')

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