Unexpected opportunities: incidental findings detected during impairment evaluations for coal workers' pneumoconiosis

Coal workers' pneumoconiosis impairment evaluations for 374 miners, predominantly from eastern Kentucky, were conducted by our department between January 1, 1989, and June 30, 1992. During a review of the cases, potentially significant findings not directly related to any detected pneumoconiosis were recorded. Sixty-five (17.4%) of the men had blood pressure > or = 150 mm Hg systolic or > or = 90 mm Hg diastolic during one measurement. Of 89 workers who had a previous diagnosis of hypertension and were being treated, 40 (44.9%) had an elevated blood pressure measurement. Twelve cases of incidental, previously undetected chest radiograph findings warranted follow-up; 9 of these were isolated pulmonary nodules. In addition, three patients were immediately referred for evaluation and treatment of conditions newly diagnosed during the examination--one for unstable angina pectoris, one for congestive heart failure, and one for recent cerebrovascular accident. These cases illustrate that physicians doing impairment evaluations, even if they are not the patient's treating physician, have the opportunity and responsibility to intervene and reduce morbidity and mortality.