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“Incidental Findings” Found to Be Unusual but Significant Events in Pediatric CT Imaging

By MedImaging International staff writers
Posted on 23 Sep 2013

The largest study of computed tomographic (CT) imaging scans taken in emergency departments across the United States for children with head injuries revealed the prevalence of “incidental findings,” i.e., results that were not expected from the injury, and categorized them by urgency.

The article was published in the August 2013 issue of the journal Pediatrics, and provides a context for doctors in emergency departments who encounter these situations. “Incidental findings are a rare but significant event,” said Dr. Nathan Kuppermann, professor and chair of emergency medicine at the University of California (UC) Davis Medical Center (Sacramento, USA) and lead investigator of the study. “It is important for doctors to look for abnormalities other than what they expect to find and to be prepared to interpret and communicate these findings to families.”

The study involved nearly 44,000 children seen for a head injury in 25 hospital emergency departments nationwide. Nearly 16,000 had CT scans to evaluate an injury, and approximately 4% of the scans revealed incidental findings ranging from enlarged tonsils to life-threatening tumors. Children with a known pre-existing brain abnormality were excluded from the analysis.

The researchers also classified the incidental findings into three categories: those that required immediate assessment or treatment, those that needed appropriate timely outpatient follow-up, and those that merited further investigation only if the problems were causing symptoms. Only 0.1% of the overall sample of CT scans fell into the most serious category.

Because of the small percentage of patients with the most urgent incidental findings, the study authors did recommend any changes to current CT scan guidelines. They believe emergency medicine physicians should continue to perform CT scans in children as is medically justified for their injury because a CT scan entails a small but known long-term risk of cancer from radiation exposure.

Advanced imaging studies, genetic analysis, and other high-technology tests have made it possible to gather data that neither the clinician nor patient expects. Determining what to do with these findings, particularly if they are likely to be insignificant to a patient’s health, can create a predicament for physicians. The authors believe physicians should weigh the patient’s right to know against financial costs and potential negative health effects from worry, further testing and perhaps even unnecessary treatment brought on by learning of the findings.

“Because the practice of medicine has embraced technologies that provide information beyond the actual clinical question, a need to develop strategies to handle unexpected information now exists,” said Alexander Rogers, assistant professor of pediatric emergency medicine at the University of Michigan Health System (Ann Arbor, USA), and lead author of the study. “Particularly in the emergency room, doctors must decide quickly whether and how to disclose information to a family with whom they have no prior relationship and do not know what their response is likely to be.”

This study is the largest pediatric multicenter description of the frequency of incidental findings on head CT scans. Moreover, it is a secondary analysis of a study that was designed to establish a decision rule for determining which children who present to the emergency room with a head injury should have a CT scan to evaluate it.

The pediatric head injury/trauma algorithm that resulted from this work has become standard in emergency departments worldwide and has helped reduce the number of unnecessary CT scans in children. Both studies were part of the Pediatric Emergency Care Applied Research Network (PECARN; Salt Lake City, UT, USA), the only US-funded pediatric emergency medicine research network. With participating academic and urban hospitals across the country, the network has access to a large number of demographically diverse populations of children being seen in emergency departments.

“The large size of this study enhances the value and generalizability of our findings,” said Dr. Kuppermann, who is the founding chair of PECARN and served as its chair until 2008. “Without the large, multicenter network provided by PECARN, we would be unable to have undertaken such a definitive study.”

Related Links:
University of Michigan Health System
University of California, Davis Medical Center
Pediatric Emergency Care Applied Research Network

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63 (216.00723266602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

64 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

65 (!!!!! 2622.8427886963): 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

66 (526.90505981445): SELECT fid FROM jos_deeppockets WHERE id=294748326 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294748326 AND published='1' LIMIT 1

67 (393.15223693848): 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`

68 (86.069107055664): select jos_twitters.link from jos_twitters where cat=10

69 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

70 (44.822692871094): select jos_google_plus.link from jos_google_plus where cat=10

71 (49.114227294922): select jos_linkedin.link from jos_linkedin where cat=10

72 (51.021575927734): SELECT fid FROM jos_deeppockets WHERE id=294748326 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294748326 AND published='1' LIMIT 1

73 (50.067901611328): 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`

74 (349.99847412109): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748326 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (417.94776916504): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748326 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

76 (49.114227294922): 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`

77 (391.00646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (80.108642578125): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (130.17654418945): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (96.08268737793): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (92.029571533203): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (283.00285339355): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748326 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (85.830688476562): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748326 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

93 (91.075897216797): 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`

94 (88.930130004883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (65.088272094727): 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 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

108 (238.18016052246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

109 (154.97207641602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

110 (54.121017456055): 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=294748326 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (82.015991210938): 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=294748326 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1454.8301696777): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

113 (85.830688476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

114 (76.055526733398): 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=294748326 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (736.95182800293): 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=294748326 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (572.91984558105): 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

117 (357.86628723145): 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

118 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

119 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

120 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

121 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

122 (128.03077697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

123 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

124 (358.10470581055): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 122185.94551086): 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

126 (232.93495178223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

127 (!!!!! 1957.893371582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

128 (!!!!! 2734.1842651367): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748326 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748326 AND type='deeppockets_item' AND published='1' LIMIT 1

129 (!!!!! 2864712.9535675): ( 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

130 (!!!!! 2081717.9679871): ( 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

131 (108.00361633301): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

132 (49.114227294922): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

133 (50.067901611328): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

134 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

135 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

136 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

137 (445.12748718262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (373.12507629395): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (149.96528625488): SELECT name FROM jos_deeppockets WHERE id=211

140 (82.969665527344): SELECT name FROM jos_deeppockets WHERE id=211

141 (427.9613494873): 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 (401.97372436523): 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

143 (987.05291748047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

144 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

145 (!!!!! 9649.9919891357): TRUNCATE TABLE jos_trademed_module

146 (574.11193847656): 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=294748326 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (641.82281494141): 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=294748326 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (460.14785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

151 (165.93933105469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

152 (!!!!! 1478.1951904297): 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

153 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

154 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

155 (!!!!! 4126.0719299316): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748326 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748326 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (90.837478637695): 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 (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)

158 (60.081481933594): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (!!!!! 4060.9836578369): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

160 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748326 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748326 AND published='1' LIMIT 1

161 (56.028366088867): select jos_twitters.link from jos_twitters where cat=10

162 (37.908554077148): select jos_facebook.link from jos_facebook where cat=10

163 (33.855438232422): select jos_google_plus.link from jos_google_plus where cat=10

164 (33.140182495117): select jos_linkedin.link from jos_linkedin where cat=10

165 (325.91819763184): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

166 (!!!!! 1441.9555664062): insert into jos_banners_delta values (14615,'2025-04-30 07:04:58','18.221.72.117','view'),(14202,'2025-04-30 07:04:58','18.221.72.117','view'),(14203,'2025-04-30 07:04:58','18.221.72.117','view')

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