Incidence and predictors of PEG placement in ALS/MND

In the Project on Death in America ALS cohort, 121 patients were followed t o examine the timing of key milestones in the course of the disease, such a s tracheostomy and PEG placement. During the 2- to 4-year follow-up period, 26.5% of patients received PEG, yielding a cumulative incidence of 48%. PE G placement occurred, on average, 16 months after patients received confirm ation of the diagnosis at our Center. Patients who received PEG were more l ikely to have tracheostomies than patients not using PEG (p < 0.01). In mul tivariate proportional hazard models that included both sociodemographic an d disease indicators, the strongest predictor of PEG use was a patient's ba seline preference for PEG: 57.1% of patients "absolutely in favor" went on to have PEG, compared to only 9.3% of those "absolutely against" (p < 0.01) . PEG users were more likely to have initiated health care proxies. These f indings suggest that patients who use PEG may be consistently proactive in the face of the disease. (C) 2001 Elsevier Science B.V. All rights reserved .