The influence of social media on recruitment to surgical trials
Authors: Bisset Carly Nichola , Carter Ben , Law Jennifer , Hewitt Jonathan , Parmar Kat , Moug Susan Joan ,   on behalf of the ELF Study Group Collaborative Authorship, Ross Bryony , Oleksiewicz Julia , Fearnhead Nicola , Jump Christopher , Boyle Jemma , Shaw Alex , Barker Jonathan , Hughes Jane , Randall Jonathan , Tonga Isileli , Kynaston James , Boal Matthew , Eardley Nicola , Kane Elizabeth , Reader Harriet , Mahapatra Sunanda Roy , Garner-Jones Michael , Tan Jessica Juliana , Mohamed Said , George Rina , Whiteman Ed , Malik Kamran , Smart Christopher J. , Bogdan Monica , Chaudhury Madhu Parna , Sharma Videha , Subar Daren , Patel Panna , Chok Sok-Moi , Lim Evelyn , Adhiyaman Vedamurthy , Davies Glesni , Ross Ellen , Maitra Rudra , Steele Colin W. , Roxburgh Campbell , Griffiths Shelly , Blencowe Natalie S. , Kirkham Emily N. , Abraham John S. , Griffiths Kirsty , Abdulaal Yasser , Iqbal Muhammad Rafaih , Tarazi Munir , Hill James , Khan Azam , Farrell Ian , Conn Gemma , Patel Jugal , Reddy Hyder , Sarveswaran Janahan , Arunachalam Lakshmanan , Malik Afaq , Ponchietti Luca , Pawelec Krystian , Goh Yan Mei , Vitish-Sharma Parveen , Saad Ahmed , Smyth Edward , Crees Amy , Merker Louise , Bashir Nahida , Williams Gethin , Hayes Jennifer , Walters Kelly , Harries Rhiannon , Singh Rahulpreet , Henderson Nikola A. , Polignano Francesco M. , Knight Ben , Alder Louise , Kenchington Alexandra , Goh Yan Li , Dicurzio Ilaria , Griffiths Ewen , Alani Ahmed , Knight Katrina , MacGoey Patrick , Ng Guat Shi , Mackenzie Naomi , Maitra Ishaan , Moug Susan , Ong Kelly , McGrath Daniel , Gammeri Emanuele , Lafaurie Guillame , Faulkner Gemma , Benedetto Gabriele Di , McGovern Julia , Subramanian Bharathi , Narang Sunil Kumar , Nowers Jennifer , Smart Neil J. , Daniels Ian R. , Varcada Massimo , Gala Tanzeela , Cornish Julie , Barber Zoe , O’Neill Stephen , McGregor Richard , Robertson Andrew G. , Paterson-Brown Simon , Raymond Thomas , Thaha Mohamed A. , English William J. , Forde Cillian T. , Paine Heidi , Morawala Alpa , Date Ravindra , Casey Patrick , Bolton Thomas , Gleaves Xuan , Fasuyi Joshua , Durakovic Sanja , Dunstan Matt , Allen Sophie , Riga Angela , Epstein Jonathan , Pearce Lyndsay , Gaines Emily , Howe Anthony , Choonara Halima , Dewi Ffion , Bennett Joanne , King Emile , McCarthy Kathryn , Taylor Greg , Harris Dean , Nageswaran Hari , Stimpson Amy , Siddiqui Kamran , In Lim Lay , Ray Christopher , Smith Laura , McColl Gillian , Rahman Mohammed , Kler Aaron , Sharma Abhi , Parmar Kat , Patel Neil , Crofts Perry , Baldari Claudio , Thomas Rhys , Stechman Michael , Aldridge Roland , O’Kelly James , Wilson Graeme , Gallegos Nicholas , Kalaiselvan Ramya , Rajaganeshan Rajasundaram , Mackenzie Aliya , Naik Prashant , Singh Kaushiki , Gandraspulli Harinath , Wilson Jeremy , Hancorn Kate , Khawaja Amir , Nicholas Felix , Marks Thomas , Abbott Cameron , Chandler Susan 
Published: July 2020

Abstract
Background
Social media has changed the way surgeons communicate worldwide, particularly in dissemination of 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-based, 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 to detect a 10% change in mortality associated with frailty. A 12-week recruitment period was selected, calculated from information submitted by participating hospitals and the numbers of emergency surgeries performed in adults aged > 65 years. 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 Twitonomy (Digonomy Pty Ltd) were used to analyse user engagement in relation to patient recruitment.

Results
After 90 days of data collection, 49 sites from Scotland, England and Wales recruited 952 consecutive patients undergoing emergency laparotomy, with data logged into a database created on REDCap. 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 (number of times users see a particular tweet) prior to March 20th 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 June 20th 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.