ObjectiveTo evaluate the association of initial clinical symptoms with need for hospitalization, intensive care, or death in ED patients within 30 days after presenting with acute symptomatic COVID-19. MethodsThis study is a retrospective case-series of patients presenting to a single ED with acute symptomatic COVID-19 from March 7-August 9, 2020. Symptomatic patients with laboratory-confirmed SARS-CoV-2 infection were eligible for this study. Patients who tested positive for COVID-19 due to screening tests but had no reasonably associated symptoms were excluded. Participants were analyzed by three categories representative of clinical severity intensive care unit (ICU) care/death, general ward admission, and ED discharge/convalescence at home. Outcomes were ascertained 30 days after initial presentation to account for escalation in severity after the ED visit. We conducted univariate and multivariable logistic regression analyses to report odds ratios (OR) with 95% confidence intervals (CI) between hospital or ICU care/death versus convalescence at home and between ICU care/death versus general ward admission. ResultsIn total, 994 patients were included in the study, of which, 551 (55.4%) patients convalesced at home, 314 (31.6%) patients required general ward admission, and 129 (13.0%) required ICU care or died. In the multivariable models, ED patients requiring hospital admission were more likely to be aged [≥] 65 years (adjusted OR [aOR] 7.4, 95% CI 5.0, 10.8), Black/African American (aOR 3.0, 95% CI 1.6, 5.8) or Asian/American Indian/Alaska Native/Other (aOR 2.2, 95% CI 1.1, 4.3), and experience dyspnea (aOR 2.7, 95% CI 2.0, 3.7) or diarrhea (aOR 1.6, 95% CI 1.1, 2.2). However, they were less likely to experience sore throat (aOR 0.4, 95% CI 0.2, 0.6), myalgia (aOR 0.5, 95% CI 0.4, 0.7), headache (aOR 0.5, 95% CI 0.4, 0.8), or olfactory/taste disturbance (aOR 0.5, 95% CI 0.3, 0.8). ED patients who required ICU care or died were more likely to experience altered mental status (aOR 3.8, 95% CI 2.1, 6.6), but were less likely to report history of fever (0.5, 95% CI 0.3, 0.8). ConclusionsCOVID-19 presents with a multitude of clinical symptoms and an understanding of the association of symptoms with clinical severity may be useful for predicting ultimate patient outcomes.