A head injury can be followed by a wide variety of problems, and advice on the detailed management of these is beyond the scope of this guideline. The value of specialist multidisciplinary follow up and rehabilitation services for head injured patients may be a subject for future guidelines; at present, the availability of these services is fragmentary and varies widely in different localities.

Information on the common physical and neuropsychological sequelae of head injury (e.g. memory problems, dizziness, anosmia, epilepsy), and advice on return to driving, work, or sport should be available and offered at the time of discharge. It may be helpful (either then or later) to make a referral to a multidisciplinary health/social services team or an appropriate community support agency. Advice on alcohol and drug use and contact numbers for victim support groups should be offered where appropriate. It may be appropriate to provide this information both to the family and to the patient.

Follow-up arrangements may be co-ordinated by the primary care team or the hospital. Patients who have post traumatic amnesia of over an hour, a fractured skull, or neuropsychological or neurological symptoms at discharge from hospital are more likely to have residual problems.¹⁴³ Simple structured advice¹⁴⁴ can help them and their families to cope with these sequelae. Evidence level Ib

Head injured patients may benefit from advice and treatment given by a variety of experts, often working as a team: neurorehabilitation physician, clinical neuro-psychologist, rehabilitation nurse, physiotherapist, occupational therapist, speech and language therapist, and medical social worker/care manager.^{143, 144, 145, 146} Continuity of care and information about the ability of the patient and family to cope in the community can be obtained by home visits from liaison social workers, occupational therapists, or other head injury workers. The more severe the head injury the more useful an interdisciplinary and goal-orientated approach to the patient's problems is likely to be, but even moderately and mildly head injured patients may benefit. Further evaluation of this approach is needed. Evidence level Ib, III and IV

A discharge letter should be sent to the general practitioner about every patient, whether or not admitted to hospital. At this time an offer should be made to review the patient in an appropriate clinic if progress is not as expected or if unforeseen problems develop.

Children suffering significant head injury should be followed-up by a specialist multidisciplinary team to assess the need for rehabilitation and should include notification to the school medical service and the primary health care team.