Using trauma video review we identified significant procedural variability in emergency department tube thoracostomy, mainly that hemodynamic abnormality led to lower proficiency scores and increased malpositioning.

Efforts are needed to define procedural benchmarks and evaluation in the context of patient outcomes.

Using this technology and methodology can help establish procedural norms.

In total, 51 videos met the inclusion criteria.

The median age was 34 years, body mass index 25.8, predominately male (75%), blunt injury (57%), with Injury Severity Score of 22.

The median procedure score was 9.

Emergency department tube thoracostomies in patients with abnormal hemodynamics had significantly lower procedure scores.

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