All road users are at risk of being involved in motor vehicle crashes (MVCs). Approximately 52.2% of all fatalities and 70.9% of all casualties related to MVCs in Kelantan were motorcycle riders and pilliori riders. A number of risk factors have been established in the relationship between traffic accidents and road-user, the vehicle as well as road and traffic conditions. The study was a cross-sectional study to identify factors associated with the severity of injury sustained by motorcyclist accident patients admitted to the Emergency Department, Hospital Universiti Sains Malaysia (HUSM), assessed through face to face interview based questionnaire and, at the same time the severity of injury was determined through Revised Trauma Score. Data analysis was done using simple and multiple logistic regressions. The study revealed that age more than 5O years, no motorcycle license, no stressful condition and crashes on two·way road showed higher risk of sustaining a more severe injury. However, sleep time of six to less than nine hours per day, crash on a straight roadway and wet road surface were associated with less severe injury. We recommend that public education, licensing and enforcement on accident prevention and safety riding should be given a priority.