Introduction: Neuropsychological testing was endorsed as the “cornerstone” of concussion management by the Vienna Concussion in Sports Group (CIS). Cognitive testing is particularly important because athletes often underreport post-concussive symptoms. This study evaluated individual and combined sensitivity of symptom report and neuropsychological testing. Method: 201 high school and college athletes who had suffered concussion while participating in sports were evaluated. All athletes had previously undergone baseline testing using the ImPACT computerized test battery, and were then tested within 1 week of injury. “Abnormal” performance was determined by use of reliable change index scores (RCIs). Results: 65% of concussed athletes reported significant increases in symptoms compared to baseline. 82% of the concussed sample demonstrated significantly poorer results on ImPACT. Addition of neuropsychological testing resulted in increased sensitivity of 17%. Combined sensitivity of symptom report and cognitive testing was 88%. Discussion: Reliance on player reported symptoms could result in poor diagnostic sensitivity and premature return-to-play. Addition of a neuropsychological protocol increases diagnostic sensitivity. Careful evaluation of both player symptoms and cognitive performance represents the most useful approach to concussion management.