Discrepancy Between Clinical Suspicion and Legal Outcomes in Suspected Child Abuse: A 10-Year Single-Center Study.

Despite mandatory reporting, many suspected child abuse cases never proceed to formal investigation in Korea. We retrospectively reviewed 83 pediatric patients evaluated for suspected child abuse at a tertiary hospital between 2015 and 2025, screened using the Finding Instrument for Non-accidental Deeds score, and analyzed clinical characteristics, injury severity, and investigative outcomes. The mean age was 4.3 years, and mechanical injury was the most common abuse type (n = 68). Twenty-four patients (28.9%) were severe cases requiring surgery or intensive care or resulting in death. Overall, 33 patients (39.8%) were determined as 'no suspicion,' including 11 of 24 severe cases (45.8%); this proportion decreased from 45.7% to 37.8% after the 2021 policy reform. A critical gap persists between medical recognition of child abuse and the legal response, warranting closer integration of clinical assessment with child protection and investigative systems.