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These pages are intended for medical professionals. Do not try to use CogState Sport to diagnose or treat yourself. CogState Sport reports must be interpreted by a doctor.

After-injury tests should be taken after the athlete's symptoms have resolved. These reports summarize whether the athlete's cognitive performance (i.e. thinking) has declined from their own baseline level of performance, and also summarize the athlete's symptoms at the time of testing.

There are two types of after-injury test reports. These are:

1. Reports which can be interpreted by any sports physician.
2. Reports which must be interpreted by a neuropsychologist, neurologist or neurosurgeon in addition to a qualified medical practitioner.

Reports which can be interpreted by any sports physician:

These reports describe the results of an after-injury test that is compared to a valid baseline test. There are 2 possible variations of this after-injury report, which depend on the combination of cognitive test performance and clinical symptom ratings. Note that the report has been generated by a computer program - it does not make decisions about whether or not an athlete is concussed, it simply measures cognitive performance.

Regardless of which type of report is returned, the CogState Sport report must not be the only criterion on which return-to-play decisions should be made. Such decisions must also take into consideration the athlete's clinical signs and symptoms, history of concussion, the results of any other investigations undertaken (e.g. MRI or CT scans), and also the possibility that false-positive or false-negative impairments may be reported. There are many factors (clinical and situational) which can result in impaired performance on CogState Sport. You should consider each of these in your evaluation of the athletes. These factors are described below.

Factors which may cause changes in performance on CogSport testing (This is not an exhaustive list. CogState Sport does not make diagnoses):

Factors which may impair performance on CogSport tests:

• Concussion and other head injury
• Learning difficulties
• Drug abuse
• Aging
• Fatigue and sleep disorders
• Chemotherapy
• Over-training
• Depression
• Diabetes and low blood glucose
• Post-operative cognitive impairment
• Attention deficit disorder
• Alcohol use and abuse
• Effects of sedating drugs
• Mental illness
• Dementia and mild cognitive impairment
• "Faking bad" or simulated cognitive impairment
• Cardiovascular illness, including stroke
• Psychiatric disorders (e.g. Schizophrenia)

Factors which may give rise to improved performance on CogState Sport tests:

• Effects of stimulant drugs
• Moderate exercise
• Effects of anti-depressant medication
• Effects of treatments to attention deficit disorder
• Effects of treatments for depression
• Effects of treatment for sleep disorders
• Practice or learning effects
• Treatment for learning difficulties

There are two symbols that can appear on an after-injury report. These are a 'green check' or a 'red cross'.

When you see a green check, and NOT the words "valid baseline", it means that the athlete's cognitive performance is equivalent to their own baseline test performance, and that they reported no symptoms of concussion at the time of testing.

This symbol does not mean that the athlete is ready to return-to-play. You must make that decision independently, based on your clinical evaluation of the athlete. You must also read the rest of the report carefully to determine what action needs to be taken.

When you see a red cross, it means either that the athlete's cognitive performance has declined from their own baseline test performance OR that the athlete has reported some symptoms of concussion at the time of testing, OR both.

The red cross may also appear if the after-injury test was not completed.

Athletes with this type of report should not be returned to play until cognition has returned to normal and symptoms have resolved.

The report may recommend that you re-test the athlete. The timing of any re-test should be based on your clinical judgment and your evaluation of the athlete. You must make that decision independently. You must also read the rest of the report carefully to determine what further action needs to be taken.

A description of each of the sections on the after-injury report is given at the end of this page.

Reports which must also be interpreted by a neuropsychologist, neurologist or neurosurgeon.

In some cases, the athlete will take an after-injury test without having previously completed a valid baseline test, or where the previous baseline test is over 12 months old. For these athletes, the after-injury report must be interpreted by a neurological specialist (neurologist, neurosurgeon) or a neuropsychologist, in addition to the athlete's physician.

In cases where this occurs, the after-injury report will clearly state that it should be interpreted by a specialist with neuropsychological expertise. Specialist interpretation is recommended because: (a) there is no baseline test data available; or (b) the athlete performed poorly on their baseline test.

In both of these situations, the post-concussion medical evaluation should include assessment for the presence of neurological, psychiatric or psychological disorders. This situation makes assessment of after-injury test data difficult, and it is recommended that such assessment be carried out by a specialist.

Sections of the after-injury report

• Codename: Identifies the athlete. For privacy reasons the athlete's name should not be used, a codename (or number) should be used. CogState Sport can only compare after injury tests with pre-injury tests taken under exactly the same codename.
• Date of Birth: Displays the athlete's date of birth, as reported by the athlete when the test was taken.
• Education: Records the highest level of education completed by the athlete, as reported by the athlete when test taken
• Handedness: Records the athlete's choice of "I am right handed", "I am left handed". The keypress responses are set so that a "yes" answer is always given with the dominant hand, or right hand if there is no dominant hand.
• Date of test / Time of test: Reports the date and time the test was taken.
• Type of test: Should say "After-injury test". If it does not, then it is a baseline and must not be used for concussion management in any way .
• Baseline test date: After injury tests are always compared with a baseline (regular) test. The date this regular test was taken is reported here.
• Test ID: For CogState Sport use, allows us to identify the particular test in case of query.
• Account username: This is the username of the account holder (e.g. team). It is not the same as codename, which identifies the athlete.
• Injury information: The answers given in this section are those reported by the athlete.
• Time since injury: The number of days since the injury occurred.
• Loss of consciousness: Reports whether the athlete lost consciousness at the time of injury?
• Post-traumatic amnesia: Reports whether the athlete had post-traumatic amnesia at the time of injury.
• Seen a doctor?: Reports whether the athlete has seen a doctor since the injury.
• Number of prior concussions: This is the number of prior concussions reported by the athlete, when they took the baseline test against which this test is being compared. Note that (a) it has been shown that athletes are extremely inconsistent in their answers to this question from year to year, even where there are no new concussions, and (b) if the patient has been concussed several times since they took the baseline test this will not be reported here. You should discuss this with the patient.

Result summary

The result summary section gives a written summary of the athlete's cognitive test performance and their symptom ratings. Two main issues are addressed:

1. Was the athlete's cognitive performance on this test at least as good as in the original test? If they have misunderstood the instructions or have failed to complete the test, as well as if their performance is worse, then they will fail on this aspect.
2. Does the athlete report symptoms associated with concussion? The result will be "worse than baseline" if these symptoms are present at all, whether or not worse than baseline. Return to play should not be contemplated until the athlete is asymptomatic.

Self-reported symptom checklist

This section records the symptoms an athlete has reported both during this test, and during previous test, including the baseline (regular) test. Points to note:

• This part of the test cannot be protected from an athlete "faking bad" at baseline, or "faking good" during an after-injury test.
• This part of the test is a slightly modified version of a set of questions which has been validated as being sensitive to concussion.
  Cognitive test results

This section reports the athlete's baseline and after-injury test performance on five tests of cognition. The score given for each test is standardized around an average of 100, with a standard deviation of 10. The 'Result' in this section can be either NO CHANGE or WORSE THAN BASELINE. If any of the 5 tests are reported as worse than baseline, then the athlete is considered to have declined from their baseline test.