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Routine Repeated CT Scans Not Required After Mild Head Trauma

By MedImaging International staff writers
Posted on 15 Jan 2013

When an initial computed tomography (CT) scan shows hemorrhaging within the brain after a mild head injury, decisions about repeated CT scanning should be based on the patient’s neurologic condition, according to a recent report.

The research was published in the January 2013 issue of Neurosurgery, the official journal of the Congress of Neurological Surgeons. The study questions the need for routinely obtaining repeated CT scans in patients with mild head trauma. “The available evidence indicates that it is unnecessary to schedule a repeat CT scan after mild head injury when patients are unchanged or improving neurologically,” according to the study by Dr. Saleh Almenawer and colleagues from McMaster University (Hamilton, Ontario, Canada.

In a review of their hospital’s trauma database, the researchers identified 445 adult patients with mild head injury who had evidence of intracranial hemorrhage (ICH) on an initial CT scan. In many trauma centers, it is standard practice to schedule a second CT scan within 24 hours after ICH is detected, to make sure that the bleeding has not progressed.

To evaluate the need for routine repeated scans, Dr. Almenawer and colleagues looked at how many patients needed surgery or other additional therapy, and whether the change in treatment was prompted by changes in the patients’ neurologic condition or based on the routine CT scan alone. (For patients whose neurologic condition deteriorated, CT was performed right away.)

Overall, 5.6% of the patients required a change in treatment after the second CT scan. Most of these patients underwent surgery (craniectomy) to relieve pressure on the brain. Nearly all patients who underwent further treatment developed neurological changes leading to immediate CT scanning. Only two patients had a change in treatment based only on routine repeated CT scans. Both of these patients received a drug (mannitol) to lessen intracranial pressure, instead of performing surgery.

Dr. Almenawer and colleagues extended the same modality to patients reported in 15 earlier series of CT scanning after mild head injury. Including the 445 new patients, the analysis included a total of 2,693 patients. Overall, 2.7% of patients had a change in management based on neurological changes. In contrast, just 0.6% had treatment alterations based on CT scans only.

Hemorrhaging within the brain is a potentially life-threatening condition, prompting routine repeated CT scans after even mild head injury. The researchers wrote, “Although CT scanners are very useful tools, in an era of diminishing resources and a need to justify medical costs, this practice needs to be evaluated.” Each scan also exposes the patient to radiation, contributing to increased cancer risk.

The new study questions the need for routine repeated CT scans as long as the patient’s neurologic condition is improving or stable. “In the absence of supporting data, we question the value of routine follow-up imaging given the associated accumulative increase in cost and risks,” Dr. Almenawer and coauthors concluded.

Neurologic examination is the “simple yet important” predictive factor leading to changes in treatment and guiding the need for repeat CT scanning after mild head injury, the researchers added. The investigators stressed that their research do not necessarily apply to patients with more severe head injury.

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61 (267.98248291016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

62 (689.02969360352): 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 (!!!!! 3986.8354797363): SELECT fid FROM jos_deeppockets WHERE id=294744252 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744252 AND published='1' LIMIT 1

64 (66.995620727539): 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 (!!!!! 3569.1261291504): select jos_twitters.link from jos_twitters where cat=10

66 (313.99726867676): select jos_facebook.link from jos_facebook where cat=10

67 (46.014785766602): select jos_google_plus.link from jos_google_plus where cat=10

68 (195.02639770508): select jos_linkedin.link from jos_linkedin where cat=10

69 (!!!!! 1968.8606262207): SELECT fid FROM jos_deeppockets WHERE id=294744252 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744252 AND published='1' LIMIT 1

70 (57.93571472168): 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 (982.99980163574): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744252 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (375.98609924316): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744252 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (200.98686218262): 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 (613.92784118652): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (263.92936706543): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (!!!!! 1019.0010070801): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (233.17337036133): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (!!!!! 5078.7925720215): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 3942.9664611816): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (!!!!! 11673.927307129): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744252 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (!!!!! 11874.914169312): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744252 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (!!!!! 11101.007461548): 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 (!!!!! 1439.094543457): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (307.08312988281): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (243.9022064209): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (198.1258392334): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (326.87187194824): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (184.05914306641): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (97.990036010742): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (504.0168762207): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (!!!!! 2635.9558105469): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (488.9965057373): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (!!!!! 1556.8733215332): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

106 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

107 (300.16899108887): 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=294744252 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1299.8580932617): 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=294744252 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (!!!!! 7858.0379486084): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

110 (337.83912658691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

111 (778.9134979248): 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=294744252 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (751.97219848633): 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=294744252 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (!!!!! 1058.1016540527): 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 (613.92784118652): 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 (818.01414489746): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

116 (317.81196594238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

117 (792.9801940918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

118 (199.0795135498): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

119 (803.94744873047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

120 (120.87821960449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

121 (499.96376037598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

122 (144.95849609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

123 (725.03089904785): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 66208.839416504): 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 (!!!!! 1257.8964233398): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744252 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744252 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (696.18225097656): ( 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 (293.01643371582): ( 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 (!!!!! 4202.127456665): 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 (!!!!! 3420.1145172119): 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 (!!!!! 1675.1289367676): 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 (51.021575927734): 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 (36.954879760742): 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 (47.922134399414): 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 (357.86628723145): 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 (237.94174194336): 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 (!!!!! 1222.8488922119): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 1129.8656463623): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (553.13110351562): SELECT name FROM jos_deeppockets WHERE id=211

139 (325.91819763184): SELECT name FROM jos_deeppockets WHERE id=211

140 (958.20426940918): 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 (!!!!! 1046.895980835): 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 (!!!!! 1380.2051544189): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

143 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

144 (!!!!! 15454.053878784): TRUNCATE TABLE jos_trademed_module

145 (338.07754516602): 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=294744252 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (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_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=294744252 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (!!!!! 1332.0446014404): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (288.96331787109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (!!!!! 2151.0124206543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

150 (273.9429473877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

151 (!!!!! 7430.0765991211): 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 (!!!!! 7589.1017913818): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

153 (!!!!! 2903.938293457): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

154 (310.89782714844): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744252 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744252 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (266.07513427734): 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 (128.03077697754): 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 (211.00044250488): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (215.05355834961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

159 (!!!!! 2535.8200073242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744252 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744252 AND published='1' LIMIT 1

160 (72.002410888672): select jos_twitters.link from jos_twitters where cat=10

161 (53.882598876953): select jos_facebook.link from jos_facebook where cat=10

162 (50.067901611328): select jos_google_plus.link from jos_google_plus where cat=10

163 (37.908554077148): select jos_linkedin.link from jos_linkedin where cat=10

164 (400.78163146973): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

165 (!!!!! 2501.0108947754): insert into jos_banners_delta values (14615,'2025-08-19 12:25:29','216.73.216.0','view'),(14202,'2025-08-19 12:25:29','216.73.216.0','view'),(14203,'2025-08-19 12:25:29','216.73.216.0','view')

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