Background Thailand, 1.7 people die from motorcycles crashed (MC), accounting for 80% of all transportation accident deaths. Although the proportion of registered MC is decreasing every year but proportion death is higher every year.

Aims To describe the situation and trends of severe injury due to MC accidents and identify high risk group, mechanism of injury, severity to suggest for injury prevention. Methods analyzed data from the National Injury Surveillance System (600–1,000 beds) during 1Jan2015–31Dec2019

Results There were 278,708 severe injuries from MC accidents, 80.3% all transport injuries. Teen ages 15–19 was the highest portion, followed by the age of 20–24. Severe head injury was 12.9% (Glasgow coma scale -GCS score 3–8). MC collided with/by MC 8.9% and MC collided with/by cars 9.6%. 93% did not wear helmet. 33% drinking alcohol before an accident, 56% collided with/by other vehicles, 44% felt down without collision. 9.7% were life threatening to high probability of death (Abbreviated Injury Scale 4–6) and higher to 10.3% in a group of no helmet waring. Meanwhile in waring helmet group was lower (5.9%). 53.3% were head Injuries (ICD 10 Chapter 19), (Of those head injuries, 71.5% Intracranial injury, 14.3% Fracture of scull and Facial bones), followed by knee and lower leg, 10.6% (82.3 Fracture of lower leg including ankle), hip and thigh 6.4% (88.7 Fracture of femur).

Conclusions Situation of MC crash problems are more severe.

Learning Outcomes In-depth MC crash investigations are needed, in order to solve problems right direction, right time.