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Factors Identified That Reduce Radiation Exposure in Children with Traumatic Injuries

By MedImaging International staff writers
Posted on 14 Feb 2013

Investigators have identified factors to minimize radiation exposure in children who experience abdominal injuries.

A study of more than 12,000 children from emergency departments (EDS) throughout the United States in the Pediatric Emergency Care Applied Research Network (PECARN) has identified seven factors that can help physicians determine the need for a computed tomography (CT) scan after blunt trauma to the abdomen. Because CT scans pose radiation hazards for children, the findings may enable doctors to determine which children do not need to be exposed to such imaging technology after a traumatic injury.

The study was published online in January 2012 first, in advance of an upcoming issue of the journal the Annals of Emergency Medicine. “CT scans involve significant radiation risk, especially for children, who are more vulnerable than adults to radiation’s effects,” said principal investigator and lead author of the study James Holmes, a professor of emergency medicine at the University of California (UC) Davis School of Medicine (Sacramento, USA). “We have now identified a population of pediatric patients that does not typically benefit from a CT scan, which is an important step in reducing radiation exposure.”

The prospective study involved children who arrived at emergency departments in the PECARN network after blunt trauma to their torsos, such as sustained from a car or bicycle crash, a fall or an assault. A variety of factors related to the children’s histories and clinical presentations were evaluated. Among these, seven were identified by statistical analysis to correlate with risk for involving a clinically important injury. The factors included evidence of trauma on the abdomen or chest (such as seat-belt marks), neurologic changes, abdominal pain, or tenderness, vomiting and abnormal breath sounds.

Children who had none of the factors when evaluated in the ED had only a 0.1% chance of having an abdominal injury that required acute intervention. For most of these cases, therefore, a CT scan, in all probability, would not provide additional useful information. According to the authors, the risk of developing a future cancer from radiation exposure from a CT scan in this setting (i.e., when lacking all seven factors) outweighs the risk of having a significant medical problem from the abdominal injury.

The investigators stated that the prediction rule is intended only to help “rule out” the need for CT for children when none of the seven factors is present. However, the rule does not authorize a CT only based on any one of the factors being present. If the prediction rule were used in that way, CT usage would actually increase over current levels. The authors stressed that clinical judgment must play an important role in determining whether a CT is required in each instance. Lengthening the time period of observation in the ED, and using findings from laboratory tests and ultrasonography, can also add to decision-making in cases of abdominal trauma.

According to Dr. Holmes, the prediction rule must be evaluated in another clinical trial designed specifically to assess its validity before being generally adopted. He expects that this will be carried out in the near future. Another related ongoing study at UC Davis Medical Center is examining the role of ultrasonography in the assessment of abdominal trauma in children, and whether increasing its usage can lead to additional decrease of the need for CT scanning.

This study also was conducted through PECARN, a network of pediatric emergency departments throughout the United States that enables researchers to collect sufficient data to perform key studies on vital issues in pediatric emergency medicine. PECARN studies have earlier led to new standards of care for infants or children presenting with diabetic crisis, head trauma, and infections.

“Because of PECARN, we are uniquely positioned to perform large studies that can provide important information,” said Dr. Nathan Kuppermann, senior investigator of the study, who is professor of pediatrics and emergency medicine and chair of the department of emergency medicine at the UC Davis School of Medicine. “The results of such studies are making emergency medicine decision-making more of a science and leading to better and safer outcomes for children.”

Related Links:
University of California Davis School of Medicine
Pediatric Emergency Care Applied Research Network

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61 (151.15737915039): 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 (571.96617126465): SELECT fid FROM jos_deeppockets WHERE id=294744784 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744784 AND published='1' LIMIT 1

63 (51.975250244141): 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 (48.160552978516): select jos_twitters.link from jos_twitters where cat=10

65 (32.901763916016): select jos_facebook.link from jos_facebook where cat=10

66 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

67 (42.915344238281): select jos_linkedin.link from jos_linkedin where cat=10

68 (66.041946411133): SELECT fid FROM jos_deeppockets WHERE id=294744784 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744784 AND published='1' LIMIT 1

69 (45.061111450195): 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 (426.05400085449): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744784 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (255.10787963867): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744784 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (43.869018554688): 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 (!!!!! 3547.9068756104): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (136.8522644043): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (72.956085205078): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (99.897384643555): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744784 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (45.061111450195): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744784 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (47.922134399414): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (69.141387939453): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

105 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

106 (88.930130004883): 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=294744784 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (667.09518432617): 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=294744784 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 3366.9471740723): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

109 (151.8726348877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

110 (59.127807617188): 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=294744784 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (671.1483001709): 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=294744784 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (668.04885864258): 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 (!!!!! 2583.0268859863): 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 (117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

115 (65.803527832031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

116 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

117 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

118 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

119 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

120 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

121 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

122 (664.94941711426): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 42937.994003296): 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 (!!!!! 4834.8903656006): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744784 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744784 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 20079.135894775): ( 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 (75.101852416992): ( 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 (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

128 (35.04753112793): 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 (65.088272094727): 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 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (265.12145996094): 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 (51.975250244141): 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 (70.095062255859): 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 (41.961669921875): 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 (!!!!! 2805.9482574463): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (736.95182800293): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (102.04315185547): SELECT name FROM jos_deeppockets WHERE id=211

138 (!!!!! 2068.9964294434): SELECT name FROM jos_deeppockets WHERE id=211

139 (!!!!! 1143.9323425293): 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 (!!!!! 1693.0103302002): 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 (!!!!! 1048.0880737305): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

142 (327.82554626465): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

143 (!!!!! 14379.978179932): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 5749.9408721924): 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=294744784 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (211.95411682129): 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=294744784 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (622.98774719238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (94.175338745117): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 4552.1259307861): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

149 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

150 (!!!!! 4385.9481811523): 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 (!!!!! 2434.9689483643): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

152 (128.98445129395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

153 (77.009201049805): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744784 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744784 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (45.7763671875): 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 (40.054321289062): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 2735.1379394531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

158 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744784 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744784 AND published='1' LIMIT 1

159 (!!!!! 1392.8413391113): select jos_twitters.link from jos_twitters where cat=10

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

161 (39.100646972656): select jos_google_plus.link from jos_google_plus where cat=10

162 (34.809112548828): select jos_linkedin.link from jos_linkedin where cat=10

163 (347.85270690918): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1269.8173522949): insert into jos_banners_delta values (14615,'2025-08-19 10:43:17','216.73.216.0','view'),(14202,'2025-08-19 10:43:17','216.73.216.0','view'),(14203,'2025-08-19 10:43:17','216.73.216.0','view')

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