Background: Auto tricycles “Tok-Tok" are one of the widely used means of transportation in Egypt nowadays and there is an increased frequency of crash injuries related to their use in transportation. Objectives: This study was designed to assess pattern, injury severity level and factors associated with severity among auto tricycle accident victims who attended Menoufia University Hospitals from the first of January to the end of December 2018. Patients and Methods: This was one year hospital based prospective study conducted on 225 victims who sustained auto tricycle vehicles' accidents. Data about victims were collected including demographic profile (age, sex and residence); accident data (nature of the incident, type of injury and type of victim); clinical data (region of the body affected, type of lesion, severity of injury, treatment and outcome). Also, Injury severity Score (ISS) was calculated and cases were classified accordingly as having minor injury and major injury. Results: The age from 20-<30 and from 10-< 20 years sustained auto tricycle injuries more than other age groups (34.7% and 28%; respectively). Males were exposed to accidents than females (77.3% vs 22.7%) and rural residents were more than urban residents (64% vs 36%). Passengers constituted 44% of victims and pedestrians constituted 22.7%. Extremities (48.0%) followed by head and neck injuries (40.3%) were the most affected areas in the studied cases. Most cases had minor trauma; mild and moderate scores (26.7%, 42.6%: respectively). Death and infirmity were significantly associated with major than minor injuries' cases (p value <0.001). Conclusion: Minor to moderate injuries were predominated in auto tricycle related accidents and the higher severity was associated with young victims and those had head and neck injuries and who needed prolonged duration of hospital stay, surgical treatment and ICU admission. Recommendations: Addition of seat belt to the design of auto tricycle for both the passenger and the driver and installations of doors for auto tricycle vehicles was recommended. Also, strict regulations about auto tricycle driving license and following the speed limit by the drivers are essential to decrease the risk for accidents.