A prospective study was conducted to test the reliability of at-home observation of head trauma victims in the rural South among a population of low educational level. During a four-month period, 99 patients entered and 90 patients finished the study. In all cases, an individual was identified as willing to accept the responsibility of observing the patient. The observer received written and verbal instructions to stay with the patient for 24 hours and to wake the patient every four hours during that time. Patients then were contacted seven to nine days after their injury and questioned as to their present symptoms and observer compliance. For patients under 15 years of age (n = 34), the observer was questioned. Thirteen percent of the observers did not remain with the patient for 24 hours, 16% passed the responsibility of observation to another individual, and 71% awoke the patient as instructed. Observers who were not the patient's mother were significantly more likely to abandon the patient during the first 24-hour period. Observer compliance for patient awakening significantly decreased with the increase in patient age. When spouses and live-in friends were combined as a group of observers and compared with parents, the parents awoke the patient significantly more often. The authors conclude that in this population, at-home observation of head trauma patients, particularly those more than 25 years old, may not be reliable. Special attention should be directed toward the care of these patients.