When compared to control articles, tweeted articles achieved significantly greater increase in Altmetric scores (Tweeted 9.4±5.8 vs. Non-Tweeted 1.0±1.8, p<0.001), Altmetric score percentiles relative to articles of similar age from each respective journal (Tweeted 76.0±9.1%ile vs. Non-Tweeted 13.8±22.7%ile, p<0.001), with greater change in citations at 1 year (Tweeted +3.1±2.4 vs. Non-Tweeted +0.7±1.3, p<0.001). Multivariable analysis showed that independent predictors of citations were randomization to tweeting (OR 9.50; 95%CI 3.30-27.35, p<0.001), Altmetric score (OR 1.32; 95%CI 1.15-1.50, p<0.001), open-access status (OR 1.56; 95%CI 1.21-1.78, p<0.001), and exposure to a larger number of Twitter followers as quantified by impressions (OR 1.30, 95%CI 1.10-1.49, p<0.001).