Better safe than sorry: An observational study of #ESALondon tweets

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Social media have recently emerged as an unavoidable mechanism for dissemination of conference content, and among those, Twitter, a micro-blogging platform, has a special place. It has been used for conference coverage by a number of medical fields, such as resuscitation and emergency medicine,1–3 but no data are so far available on the use of Twitter in the context of anaesthesia meetings.
With that in mind, we set out to learn about Twitter activity built around Euroanaesthesia 2016 ( To do so, we accessed Twitter's application programme interface searching for tweets containing the official conference hashtag (#ESALondon) and published from 25 May to 5 June 2016, using the R programing language.4
We retrieved 4117 tweets, created by 717 user accounts. The number of tweets on the London conference was approximately double that at the previous year's meeting in Berlin, whereas the attendance was roughly the same (∼7000; Combined, those figures can be seen as growing interest of ESA members in Twitter and imply an increasing impact of the conference on social media and, hence, society. However, one should note that only one-third of the tweets (n = 1527; posted by 417 users) were original content, whereas the others were re-tweets (broadcasts of previously published tweets).
Furthermore, it is insightful to consider tweeting on the #ESALondon in the context of other major meetings, such as the Society for Academic Emergency Medicine in 2011 (#SAEM11), the International Conference of Emergency Medicine in 2012 (#ICEM2012) and the European Resuscitation Council (ERC) meeting in 2015 (#erc15prague). The ratio of tweets per delegate in London was approximately 0.6 (4117 over 7000), which is twice as high as the tweet/delegate ratio of 0.3 at #SAEM11,3 but several times lower than the tweet to delegate ratios at #erc15prague (3.1)2 and #ICEM2012 (1.95).1 When considering the proportion of original tweets, #ESALondon with 36% was comparable with #erc15prague,2 whereas the fractions of original tweets at #SAEM11 (67%)3 and #ICEM2012 (69%)1 were twice as high. If we put together these numbers with the observation that many delegates were not involved in social media, we see ample opportunities for improvement. For instance, ESA could offer crash courses on Twitter at a pre-designated Twitter hotspot or include a session on social media. The congress hashtag could also be made more prominent on the congress webpage and marketing material and could be referred to during the opening ceremony.
By using the number of re-tweets and favourites per tweet as a measure of a tweet's popularity, we observed that the most popular tweet (21 re-tweets and 12 favourites) was posted by @Manu_Malbrain: ‘Well 50 bags of regular salt potato chips = 1 bag of [0.9%] saline #ESALondon’. That is an excellent example of an educational tweet: an informative and easy-to-grasp illustration of the actual amount of salt in a bag of saline (0.9% NaCl, which translates to 154 mmol of sodium per liter). The second most popular Tweeter entry (seven re-tweets and 15 favourites) was made by @traumagasdoc: ‘So …. Surgeons aren’t terribly good at assessing muscle relaxation according to the #ESALondon this morning’. This points to a very important topic, that is difference in assessment of muscle relaxation between an anaesthesiologist and a surgeon. Although of high clinical relevance (safety!), the issue is only sporadically addressed in the literature in the form of case reports.5,6
Next, we explored the text of the tweets by creating a word cloud of the most frequent words. As seen in Fig. 1a, those included ‘esa’, ‘esahq’, ‘safety’, ‘airway’, ‘management’ and ‘care’.
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