The influence of social media on recruitment to surgical trials.

Abstract Background Social media is changing the way surgeons communicate worldwide with a key role in disseminating trial results. However, it is unclear if social media could be used in recruitment to surgical trials. This study aimed to investigate the influence of Twitter in promoting surgical recruitment in The Emergency Laparotomy and Frailty (ELF) Study. Methods The ELF Study was a UK prospective, observational cohort that aimed to assess the influence of frailty on 90-day mortality in older adults undergoing emergency surgery. A power calculation required 500 patients to be recruited in 12 weeks to detect a 10% change in mortality associated with frailty. A Twitter handle was designed (@ELFStudy) with eye-catching logos to encourage enrolment and inform the public and clinicians involved in the study. Twitter Analytics and an online analytics tool (Twitonomy; Digonomy Pty Ltd) were used to analyse trends in user engagement. Results After 90 days of data collection, a total of 49 sites from Scotland, England and Wales recruited 952 consecutive patients undergoing emergency laparotomy. Target recruitment (n=500) was achieved by week 11. A total of 591 tweets were published by @ELFStudy since its conception, making 218,136 impressions at time of writing. The number of impressions prior to March 20 th 2017 (study commencement date) was 23,335 (343.2 per tweet), compared to the recruitment period with 114,314 impressions (256.3 per tweet), ending on June 20 th 2017. Each additional tweet was associated with an increase in recruitment of 1.66 (95%CI 1.36 to 1.97; p<0.001). Conclusion The ELF Study over-recruited by nearly 100%, reaching over 200,000 people across the U.K. Branding enhanced tweet aesthetics and helped increase tweet engagement to stimulate discussion and healthy competition amongst clinicians to aid trial recruitment. Other studies may draw from the social media experiences of the ELF Study to optimise collaboration amongst researchers. Trial Registration This study is registered online at www.clinicaltrials.gov (registration number NCT02952430) and has been approved by the National Health Service Research Ethics Committee.